# Early Experience with Tarlatamab (T-Cell Engagers) for Extensive-Stage Small Cell Lung Cancer (ES-SCLC) in Canada: Lessons Learned and Implementation Strategies

## TL;DR

This paper shares early experiences and strategies for safely implementing tarlatamab, a new immunotherapy for aggressive lung cancer, in Canadian hospitals.

## Contribution

The paper provides practical insights and lessons learned to help other institutions adopt tarlatamab more efficiently and safely.

## Key findings

- Tarlatamab shows promise in treating extensive-stage small cell lung cancer but requires careful monitoring due to serious side effects.
- Canadian cancer centers are developing protocols to manage adverse events like cytokine release syndrome and neurotoxicity.
- Sharing early implementation strategies helps improve the adoption of T-cell engagers in clinical practice.

## Abstract

Small cell lung cancer (SCLC) is an aggressive form of lung cancer that often spreads quickly and is hard to treat after initial therapy. Tarlatamab is a new type of immunotherapy, called a T-cell engager, that helps the body’s immune system attack cancer cells by targeting a protein called DLL3 found on SCLC cells. Clinical trials show that tarlatamab can shrink tumours and help patients live longer, even when other treatments have stopped working. Because these types of drugs can cause serious side effects, hospitals need special plans to monitor patients closely during the first doses. In this paper, Canadian cancer centres are sharing their early experiences to help others adopt this treatment safely and efficiently. The goal is to help guide future care and make these promising therapies more accessible to people across the country.

As bispecific T-cell engagers (TCEs) gain traction in the oncology treatment landscape, cancer centres must develop robust clinical pathways to ensure their safe and efficient delivery. Given the limited experience of the Canadian medical oncology community with TCEs, collecting and publishing early clinical experiences with these novel agents will be essential to inform best practices and support their safe and effective adoption across the broader Canadian oncology community. The approval of tarlatamab, the first-in-class delta-like ligand 3 (DLL3)-targeted TCE for extensive-stage small cell lung cancer (ES-SCLC), underscores the importance of sharing early clinical experience with this agent, particularly given its unique safety profile, specific monitoring requirements, and use in a population that often has multiple comorbidities. Like other TCEs, tarlatamab is associated with cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS), adverse events (AEs) that necessitate the development of dedicated protocols by medical oncologists and multidisciplinary inpatient and outpatient clinical teams to ensure prompt recognition and management of these associated toxicities. By sharing insights into administration protocols, dose ramp-up procedures, post-cycle 1 monitoring, and AE management strategies implemented at their centres, early adopters of tarlatamab can help other institutions develop and refine their own protocols more efficiently. Lessons learned during the early implementation phase, including the roles of various healthcare providers and the transition from inpatient to outpatient care, should facilitate the smoother integration of tarlatamab and other TCEs for solid tumours into clinical pathways across Canada.