Imdelltra (tarlatamab) is a bispecific T-cell engager targeting DLL3/CD3, indicated for the treatment of extensive-stage small-cell lung cancer (ES-SCLC) that has progressed after platinum-based chemotherapy.

Precautions for Imdelltra (Tarlatamab) Administration

Confirmation of Indications

Target Population: Adult patients with ES-SCLC whose disease has progressed following platinum-based chemotherapy.

Contraindications

There are no absolute contraindications, but the following risks should be assessed:

Active infections (e.g., uncontrolled bacterial, fungal, or viral infections).

Contraindicated in pregnancy (may cause fetal harm).

Infusion Requirements

Administer via intravenous infusion over 1 hour, using an infusion pump for constant-rate infusion (250 mL/h).

Avoid using closed-system transfer devices (CSTD), as they may lead to dosage errors.

Premedication and Concomitant Medications

1 hour before infusion: Intravenous administration of 8 mg dexamethasone (or equivalent medication).

After infusion: Intravenous infusion of 1 L normal saline over 4–5 hours.

Prevention of Cytokine Release Syndrome (CRS): The above regimen is recommended for the entire duration of the first treatment cycle.

Pregnancy/Lactation

Confirm pregnancy status before medication use. Women of childbearing age must use contraception until 2 months after the last dose.

Contraindicated during lactation.

Monitoring During Imdelltra (Tarlatamab) Treatment

Cytokine Release Syndrome (CRS)

For Day 1 and Day 8 of the first cycle, monitor the patient in the hospital for 22–24 hours after infusion. A caregiver must be available within 48 hours, and the patient should be within 1 hour of a medical facility.

For subsequent cycles, adjust the monitoring duration based on toxicity (e.g., only 2 hours of observation is required after Cycle 5).

Neurotoxicity (Including ICANS)

Key Symptoms: Confusion, seizures, muscle weakness, speech disorders.

ICE Score: Used for grading ICANS (score range: 0–9). A score of ≤ 2 indicates severe toxicity, requiring treatment discontinuation.

Management Principles:

Grade 1–2 neurotoxicity: Suspend medication and administer 10 mg dexamethasone intravenously.

Grade 3–4 neurotoxicity: Permanently discontinue medication and consult a neurologist.

Laboratory Monitoring

Complete Blood Count: Before each dose and when clinically indicated (with focus on neutrophils, hemoglobin, and platelets).

Liver Function: Alanine transaminase (ALT)/aspartate transaminase (AST) and bilirubin (before each dose).

Electrolytes: Sodium, potassium, and uric acid (especially during CRS).

Management of Abnormalities

Grade 3–4 Neutropenia: Suspend medication and consider granulocyte colony-stimulating factor (G-CSF) support.