Thoracic Oncology

Hi everyone,

I'd love to hear what everyone is doing for tarlatamab monitoring right now. It's an ever-evolving process for us at the moment. 

Outpatient administration + monitoring for C1D1+D8 is reserved for our ECOG 0-1, lower disease burden, no active CNS disease. We administer at 5PM on a Wednesday and monitor until 11PM in our outpatient infusion center. The patient returns to the infusion center the next morning at 7AM and stays until ~3PM for observation and vital sign monitoring. We try to manage Grade 1 CRS in the outpatient setting if we can.

All other patients are admitted for 24 hours of inpatient monitoring for C1D1+D8.

Thanks in advance for sharing.

Lia

We're still admitting patients for the first 2 doses as our initial patient experiences after FDA approval had significantly higher rates of ICANS than was reported in trials, so we were hesitant to shift towards outpatient monitoring. That said - the emerging 6-8h data from the DeLLphi-300 & 304 trials are certainly encouraging. We haven't met yet as a group but I anticipate we may do so in the next ~6mo to determine which patients best qualify for this approach. Hopefully there will be some labeling changes which support this as well. 

-Kevin

Hi everyone,

I'd love to hear what everyone is doing for tarlatamab monitoring right now. It's an ever-evolving process for us at the moment. 

Outpatient administration + monitoring for C1D1+D8 is reserved for our ECOG 0-1, lower disease burden, no active CNS disease. We administer at 5PM on a Wednesday and monitor until 11PM in our outpatient infusion center. The patient returns to the infusion center the next morning at 7AM and stays until ~3PM for observation and vital sign monitoring. We try to manage Grade 1 CRS in the outpatient setting if we can.

All other patients are admitted for 24 hours of inpatient monitoring for C1D1+D8.

Thanks in advance for sharing.

Lia

I can echo what Kevin's team is doing for our group here at Hopkins. We struggle with solid tumor bed space inpatient so the sooner we can get our patients treated in the outpatient setting, the better. One of the issues has been the inability to expand our OETC (think of it as urgent care for oncology) hours to 24/7 given staffing challenges of APPs. Once we can get staffing for 24/7 OETC, we will likely treat these patients in the outpatient infusion clinic with monitoring in OETC (if still 22 hrs post) or in infusion with transfer to OETC if a labeling change shortens the required monitoring. We have not seen any cases of ICANs yet but we have had some CRS and have had to administer tocilizumab. Our biggest struggle has been the education of ALL of the solid tumor attendings and residents as luck would have it, most of our CRS events have occurred on the weekend or in the middle of the night when our inpatient clinical pharmacy specialists for MedOnc are off. 

We're still admitting patients for the first 2 doses as our initial patient experiences after FDA approval had significantly higher rates of ICANS than was reported in trials, so we were hesitant to shift towards outpatient monitoring. That said - the emerging 6-8h data from the DeLLphi-300 & 304 trials are certainly encouraging. We haven't met yet as a group but I anticipate we may do so in the next ~6mo to determine which patients best qualify for this approach. Hopefully there will be some labeling changes which support this as well. 

-Kevin

Hi everyone,

I'd love to hear what everyone is doing for tarlatamab monitoring right now. It's an ever-evolving process for us at the moment. 

Outpatient administration + monitoring for C1D1+D8 is reserved for our ECOG 0-1, lower disease burden, no active CNS disease. We administer at 5PM on a Wednesday and monitor until 11PM in our outpatient infusion center. The patient returns to the infusion center the next morning at 7AM and stays until ~3PM for observation and vital sign monitoring. We try to manage Grade 1 CRS in the outpatient setting if we can.

All other patients are admitted for 24 hours of inpatient monitoring for C1D1+D8.

Thanks in advance for sharing.

Lia