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.
