Abstract Introduction Tarlatamab is a novel bispecific T-Cell engager immunotherapy that targets DLL-3 on the surface of small cell lung cancer and CD3, a receptor on T-Cells, and was recently approved for the treatment of patients with previously treated small-cell lung cancer. Cytokine release syndrome (CRS) is a well known adverse effect of Tarlatamab. Based on current guidelines, Tocilizumab, an IL-6 antagonist, is reserved for CRS Grade 3 and above. Here, we present the case of early initiation of Tocilizumab in Grade 2 CRS to mitigate progression and improve overall outcome. Case Presentation A 62 year old female was admitted to the hospital for initiation of Tarlatamab as a part of third line therapy for small cell lung cancer. Within a few hours, the patient developed a fever to 39 Celsius, tachycardia in the 110s, hypoxia requiring 4L Nasal Cannula, and hypotension with MAPs in the low 60s, consistent with Grade 2 CRS. The patient was treated conservatively with acetaminophen, IV fluids, and 8 mg dexamethasone. Although the patient initially responded to the symptomatic treatment, she began developing hypotension again with MAPs in the low 60s. Given the patient’s repeated hemodynamic instability, tocilizumab was administered preemptively at Grade 2 CRS to avoid aggressive hemodynamic support using vasopressors and escalation of care to ICU. The patient demonstrated rapid resolution of her hemodynamic instability, with blood pressure, heart rate, and temperature all returning within normal limits. Discussion This case highlights the potential early use of IL-6 antagonists in grade 2 CRS, deviating from the standard threshold of grade 3 CRS, to provide high value care and mitigate aggressive escalation of care. In our patient, the clinical progression was heading towards vasopressor support and ICU admission, which would extend length of hospital stay, expose the patient to high risk medications, and require allocation of limited ICU resources on our patient. Early administration of tocilizumab in this setting prevented further hemodynamic compromise and safely altered the disease trajectory. As medications such as tarlatamab become more widely used, early intervention strategies may help improve outcomes while limiting side effects and optimizing resource stewardship. Further studies are needed to define the optimal timing of IL-6 blockade in CRS management. This abstract is funded by: None
Syed et al. (Fri,) studied this question.