TARLATAMAB for Small cell lung cancer|Brain metastases

Inclusion criteria

• {"criterion_text":"-\tPatients with pathology proven metastatic SCLC"}
• {"criterion_text":"-\tPretreated with at least platinum-doublet chemotherapy with or without immunotherapy, no max-imum of previous lines of systemic therapy"}
• {"criterion_text":"-\tAt least one asymptomatic active (newly diagnosed or unequivocally progressive) untreated brain metastasis ≥ 5mm: o\tSubjects with largest measurable intracranial lesion ≥5 mm but <10mm may be allowed to enroll upon agreement with investigator (for patients with target lesions of ≥ 5mm but <10 mm, 1.5 mm slice thickness brain MRI is required). o\t\"Untreated\" refers to the lesion not being previously treated with stereotactic radiosur-gery/therapy (SRS/SRT) or surgery. o\tPrior treatment with whole brain radiation therapy or local surgery is permissible provided unequivocal progression in the lesion has since occurred"}
• {"criterion_text":"-\tWHO/ECOG PS 0-1 and estimated life expectancy 12 weeks or more"}
• {"criterion_text":"-\tFor at least 7 days prior to study start: Patient must be asymptomatic from CNS metastases and on a stable dose of anti-epileptics and corticosteroids. Maximum dose of steroids is 10 mg predniso-lone or equivalent/day, dose should be noted."}
• {"criterion_text":"-\tAdequate organ and bone marrow function, defined as: o\tHematological function: \tAbsolute neutrophil count ≥1.5 x109/L \tPlatelet count ≥ 100 x109/L \tHemoglobin ≥ 5.6 mmol/l o\tCoagulation function: \tProtrombin time (PT)/ international normalized ratio (INR) and partial thrombo-plastin time (PTT) or activated partial thromboplastin time (APTT) ≤ 1.5 x institu-tional upper limit of normal (ULN) except for subjects receiving anticoagulation, who must be on a stable dose of anticoagulant therapy for 6 weeks prior to start of study treatment. o\tRenal function: \tEstimated glomerular filtration rate (eGFR) based on Modification of Dietin Renal Disease (MDRD) calculation < 30 mL/min/1.73 m2 o\tHepatic function: \tAspartate aminotransferase (AST) and alanine aminotransferase (ALT) < 3x ULN (or < 5x ULN for subjects with liver metastases) \tTotal bilirubin < 1.5x ULN (or < 2x ULN for subjects with liver metastases), except for subjects with Gilberts disease o\tPulmonary function: \tNo oxygen supplementation o\tCardiac function: \tCardiac ejection fraction ≥50%, no clinically significant pericardial effusion as de-termined by an echocardiogram (ECHO) or multigated acquisition (MUGA) scan, and no clinically significant electrocardiogram (ECG) finding"}
• {"criterion_text":"-\tAge 18 years or older"}
• {"criterion_text":"-\tSigned and written informed consent"}

Exclusion criteria

• {"criterion_text":"-\tSymptomatic BM (if asymptomatic with corticosteroids with a maximum dose of steroids of 10 mg prednisolone or equivalent/day, the patient is eligible). If in doubt, discussion with the sponsor is necessary"}
• {"criterion_text":"-\tHistory of arterial thrombosis (e.g. stroke or transient ischemic attack) within 6 months prior to first dose of study treatment"}
• {"criterion_text":"-\tEvidence of ILD or active, non-infectious pneumonitis"}
• {"criterion_text":"-\tHistory of solid organ transplant"}
• {"criterion_text":"-\tMajor surgical procedures within 28 days prior to first dose of study treatment"}
• {"criterion_text":"-\tPresence of active HIV or hepatitis infection o\tHIV infection: subjects with HIV infection on antiviral therapy and undetectable viral load are permitted with a requirement for regular monitoring for reactivation for the duration of the treatment on study per local or institutional guidelines o\tActive hepatitis C infection (subjects with detectable hepatitis C antibody [HCV Ab] and hepatitis C virus (HCV) RNA viral load above the limit of quantification) are not allowed. Subjects with presence of HCV antibody (HCV Ab positive) and HCV RNA viral load below the limit of quantification (HCV RNA negative) with or without prior treatment are allowed o\tActive hepatitis B infection (subjects with presence of hepatitis B surface antigen [HBsAg-positive] and hepatitis B virus (HBV) DNA viral load above the limit of quantification [HBV DNA positive) are not allowed. Subjects with resolved HBV infection, defined as absence of HBV surface antigen (HBsAg-negative) and presence of HBV core antibody (anti-HBc posi-tive) followed by an HBV DNA viral load below the limit of quantification (HBV DNA nega-tive) are allowed with a requirement for regular monitoring for reactivation for the dura-tion of treatment on the study and assessing the need for HBV prophylaxis therapy per lo-cal or institutional guidelines. Subjects with inactive HBV infection inactive carrier state, de-fined as presence of HBV surface antigen (HBsAg-positive) and HBV DNA viral load below the limit of quantification (HBV DNA negative) are allowed with the requirement for regular monitoring for reactivation for the duration of the treatment on the study and assessing the need for HBV prophylaxis therapy per local or institutional guidelines."}
• {"criterion_text":"-\tReceiving systemic corticosteroid therapy or any other form of immunosuppressive therapy within 14 days prior to first dose of study treatment o\tLow-dose corticosteroids (prednisone ≤ 10 mg per day or equivalent is permitted during the study) o\tAdditionally, for CNS metastases specifically a maximum dose of steroids is 4 mg dexame-thasone or equivalent/day, dose should be noted."}
• {"criterion_text":"-\tSubjects with symptoms and/or clinical signs and/or radiographic signs that indicate an acute and/or uncontrolled active systemic infection within 7 days prior to the first dose of study treat-ment o\tNote: simple urinary tract infection and uncomplicated bacterial pharyngitis are permitted if responding to active treatment. Subjects requiring oral antibiotics who have been afe-brile > 24 hours, have no leukocytosis, nor clinical signs of an infection are eligible. Screen-ing for chronic infectious conditions is not required unless otherwise noted as exclusion cri-teria."}
• {"criterion_text":"-\tTreatment with live virus, including live-attenuated vaccination, within 4 weeks prior to the first dose of study treatment. Inactive vaccines (e.g. non-live or non-replication agent) and live viral non-replicating vaccines (e.g. Jynneos for mpox infection) within 30 days prior to first dose of study treatment"}
• {"criterion_text":"-\tPrior therapy with any selective inhibitor of the DLL3 pathway"}
• {"criterion_text":"-\tReceiving another anticancer therapy. Adjuvant hormonal therapy for resected breast cancer is permitted."}
• {"criterion_text":"-\tLeptomeningeal metastases (evaluated with MRI brain)"}
• {"criterion_text":"-\tTreatment in an alternative investigational trial within 28 days prior to enrollment"}
• {"criterion_text":"-\tFemale subjects of childbearing potential unwilling to use protocol specified method of contracep-tion (appendix 3) during treatment and for an additional 60 days after the last dose of tarlatamab"}
• {"criterion_text":"-\tFemale subjects who are breastfeeding or who plan to breastfeed while on study through 60 days after the last dose of tarlatamab"}
• {"criterion_text":"-\tFemale subjects planning to become pregnant or donate eggs while on study through 60 days after the last dose of tarlatamab"}
• {"criterion_text":"-\tFemale subjects of childbearing potential with a positive pregnancy test assessed at screening by a highly sensitive serum pregnancy test"}
• {"criterion_text":"-\tMale subjects with a female partner of childbearing potential who are unwilling to practice sexual abstinence (refrain from heterosexual intercourse) or use contraception during treatment and for an additional 60 days after the last dose of tarlatamab"}
• {"criterion_text":"-\tMale subjects with a pregnant partner who are unwilling to practice abstinence or use a condom during treatment and for an additional 60 days after the last dose of tarlatamab"}
• {"criterion_text":"-\tMale subjects unwilling to abstain from donating sperm during treatment and for an additional 60 days after the last dose of tarlatamab"}
• {"criterion_text":"-\tSubject has known sensitivity to any of the products or components to be administered during dos-ing of tarlatamab."}
• {"criterion_text":"-\tHistory or evidence of any other clinically significant disorder, condition or disease (with the excep-tion of those outlined above) that, in the opinion of the investigator, would pose a risk to subject safety or interfere with the study evaluation, procedures or completion."}
• {"criterion_text":"-\tBM in eloquent area (to be discussed with neuro-oncologist)"}
• {"criterion_text":"-\tSubjects likely to not be available to complete all protocol-required study visits or procedures, and/or to comply with all required study procedures to the best of the subject and investigators knowledge."}
• {"criterion_text":"-\tContra-indication for MRI"}
• {"criterion_text":"-\tPrior history of severe or life-threatening events from any immune-mediated therapy"}
• {"criterion_text":"-\tGrade 2 or higher toxicity from previous systemic therapy, except for alopecia"}
• {"criterion_text":"-\tHistory of other malignancy within the past 2 years, with the following exceptions: o\tMalignancy treated with curative intent before enrolment, with no known active disease and felt to be at low risk for recurrence by the treating physician, after discussion with the sponsor o\tAdequately treated non-melanoma skin cancer or lentigo maligna without evidence of dis-ease o\tadequately treated cervical cancer in situ without evidence of disease o\tadequately treated breast ductal carcinoma in situ without evidence of disease o\tprostatic intraepithelial neoplasia without evidence of prostate cancer o\tadequately treated urothelial papillary non-invasive carcinoma or carcinoma in situ"}
• {"criterion_text":"-\tActive or prior documented autoimmune or inflammatory disorders (including inflammatory bowel disease [e.g. colitis or Crohn’s disease], systemic lupus erythematosus, sarcoidosis, granulomatosis with polyangiitis, Graves’ disease, rheumatoid arthritis, hypophysitis, uveitis, etc), autoimmune pneumonitis, and autoimmune myocarditis. The following are exceptions to this criterion: o\tSubjects with vitiligo or alopecia o\tSubjects with hypothyroidism (e.g. following Hashimoto syndrome) stable on hormone re-placement o\tAny chronic skin condition that does not require systemic therapy o\tSubjects without active disease in the last 5 years may be included but only after consulta-tion with the sponsor o\tSubjects with coeliac disease controlled by diet alone"}
• {"criterion_text":"-\tMyocardial infarction and/or symptomatic congestive heart failure (New York Heart Association > class II, appendix 2), within 6 months prior to first dose of study treatment"}

Primary endpoints

• {"endpoint_text":"-\tBM ORR (RANO-BM). This will be evaluated with MRI brain after six weeks of treatment and there-after every six weeks. Confirmed BM ORR according to RANO-BM will be measured at 12 weeks.","definition_or_measurement_approach":"Evaluated with MRI brain after six weeks of treatment and thereafter every six weeks; confirmed BM ORR according to RANO-BM will be measured at 12 weeks."}

Secondary endpoints

• {"endpoint_text":"All imaging related endpoints will be measured with MRI brain for BM related outcomes and CT chest and upper abdomen for extracranial related outcomes after six weeks of treatment and thereafter eve-ry six weeks. -\tKey secondary: BM DCR (RANO-BM), CNS PFS (RANO-BM) -\tExtracranial ORR and DCR (RECIST 1.1) -\textracranial PFS (based on RECIST 1.1) -\toverall PFS (based on RANO-BM for BM and RECIST 1.1 for extracranial lesions) -\tOS -\tSafety according to CTCAE v 5.0 during every visit","definition_or_measurement_approach":"Imaging endpoints: MRI brain for brain metastasis outcomes and CT chest/upper abdomen for extracranial outcomes measured after six weeks of treatment and every six weeks thereafter. Specific measures: BM DCR and CNS PFS by RANO-BM; extracranial ORR/DCR and PFS by RECIST 1.1; overall PFS using RANO-BM for BM and RECIST 1.1 for extracranial lesions; OS; safety per CTCAE v5.0 assessed at every visit."}

Netherlands

Earliest CTIS Part Ii Submission Date

20-03-2026

Latest Decision Or Authorization Date

15-04-2026

Processing Time Days

26

Number Of Sites

4

Number Of Participants

35

Primary sponsor

Full Name

Academisch Ziekenhuis Maastricht

Organisation Type

Hospital/Clinic/Other health care facility

Country Of Registered Address

Netherlands

Third parties

• {"country":"","full_name":"AMGEN","duties_or_roles":"Source of monetary support","organisation_type":""}