Would you consider delaying tarlatamab initiation in a patient with ES SCLC who recently completed RT for CNS disease, given the concern for immune effector cell-associated neurotoxicity syndrome (ICANS)?

I would not delay beyond what we already do for other systemic treatments. We tend to wait at least a week or more after whole brain RT and systemic therapy of any nature. I do not think this is any different.

This is a good question and an important concern. This largely depends on the type of radiation (whole brain versus stereotactic radiosurgery), the size of the brain metastases treated, and the time from radiotherapy to treatment (given the risk for possible radiation necrosis, which is a confounder...

In patients with brain metastasis, immunotherapy in combination with stereotactic radiosurgery (SRS) or whole brain radiation therapy (WBRT) can maximize the anti-tumor effect. Data from one prospective and multiple retrospective studies support the safety of radiation and immunotherapy either concu...

The other mirrored question would be:

Should we delay whole brain or CNS treatment if asymptomatic and follow response to BITE inhibitor instead?

Since the effects of radiation on the brain are long-lasting and considering the aggressive nature of SCLC, I would not delay BITE too many days after completing a rapid course of XRT to the brain and monitor aggressively for ICANS and intervene promptly.