Bingnan Zhang

Several of my patients this past Friday clinic had weight loss due to poor appetite, not hungry and thus not eating. One patient’s diet consisted of only a bowl of cereal and a pancake in the morning a day and she lost 10 lb in the past 2 weeks. In addition to counseling in clinic and placed nutrition consult, later I started asking ChatGPT on some of the simple calorie and protein counting so I can better counsel my patients. The output is pretty good (The prompt is for 50kg adult but one can do the math for 1.1-1.5g/ kg of protein daily for reference). I have to admit my ignorance on nutrition counseling but research this made me think we need to have nutrition counseling on all cancer patients and not just to trigger a dietician consult when there’s significant malnutrition. No cancer therapy would work well if patients are cachectic and not eating.

This is very nice paper, in addition to the previous one by Torasawa that really taught us a lot of TIAN in patient with SCLC and brain mets. We have also seen pseudoprogression in the brain by itself without ICANS or TIAN (scary to wait and see but ultimately happy result )- interesting question to ponder re: what are the factors contributing to these different phenomena

Happy to report our experience treating patients with metastatic atypical carcinoid and large cell neuroendocrine carcinoma with tarlatamab; high response rates, unusual toxicity profile especially in atypical carcinoid cohort with pain flare, myalgia and generalized fatigue / weakness ( see narrative description for more detail in the paper) however the toxicities may also be linked to response - including a patient received only one 1mg priming dose and achieved partial response for over 9 months without additional therapy. DLL3 level matters ( median level higher in atypical carcinoid 80% of cells, more than sclc even) but definitely not the whole story, the immune compartment / implications remain to be explored. DLL3
T cell engagers should be considered for these patients and optimal dose and biomarkers are open questions jtocrr.org/article/S2666-…

Thanks for the shout out @StephenVLiu ! What really intrigued me is the unusual responses and toxicities ( likely immune mediated) in the atypical carcinoid cohort: 2 out of 5 patients had limited tarlatamab exposure , one only received 1 priming dose and had a PR for 9 months, another one also had intermittent doses due to low level- persistent toxicity but with ongoing PRs now over 8 months as well- detailed description in the paper, definitely suspect immune component playing a major role here, in addition to DLL3 level.

Huge milestone for improving the treatment of extensive stage SCLC. Feeling happy and hopeful for our patients. Huge congratulations to the entire clinical trial team, to Amgen, to the study investigators and the excellent presentation and discussion by @sands_jacob @StevenLin_MDPhD The work continues - let’s make sure tarlatamab gets wide access, and other DLL3 T cell engagers get incorporated into the treatment paradigm (in clinical trials), and let’s find better solutions for those DLL3 T cell engagers don’t work in.