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Panelists discuss how tarlatamab’s toxicity profile differs from traditional cytotoxic therapies, highlighting its immune-related adverse effects such as cytokine release syndrome and immune effector cell–associated neurotoxicity syndrome, while noting its lower risk of myelosuppression and long-term organ damage compared with chemotherapy, which tends to cause cumulative toxicities such as bone marrow suppression.

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Panelists discuss how dose reductions in the NAPOLI-3 trial paradoxically led to improved survival outcomes (12.6 months for nanoliposomal irinotecan reductions and 13.5 months for oxaliplatin reductions vs shorter survival with full doses), supporting their clinical approach of maintaining patients on tolerable doses for longer treatment duration rather than pursuing maximum dose intensity.

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Panelists discuss how adverse event profiles differ between regimens—with FOLFIRINOX causing high rates of neutropenia and neuropathy and NALIRIFOX showing lower neuropathy rates but higher grade 3 diarrhea—making patient-specific factors crucial for treatment selection and emphasizing the importance of dose adjustments and patient education.