eCase - Targeting DLL3 in ES-SCLC

Introduction

In this module, Carl M. Gay, MD, PhD, discusses the currently available evidence for and clinical application of agents targeting delta-like ligand 3 (DLL3) including emerging T-cell engagers in extensive-stage (ES) small-cell lung cancer (SCLC).

The key points discussed in this module are illustrated with thumbnails from the accompanying downloadable PowerPoint slideset, which can be found here or downloaded by clicking any of the slide thumbnails in the module alongside the expert commentary.

Clinical Care Options plans to measure the educational impact of this activity. Some questions will be asked twice: once at the beginning of the activity, and once again after the discussion that informs the best choice. Your responses will be aggregated for analysis, and your individual responses will not be shared. Thank you in advance for helping us assess the impact of this education.

Before continuing with this educational activity, please take a moment to answer the following questions.

How many people with SCLC do you provide care for in a typical month?

A.
1-5
B.
6-10
C.
11-15
D.
16-20
E.
>20
F.
Not applicable

Which of the following most accurately describes how T-cell engager therapies targeting DLL3 work in patients with ES-SCLC?

A.
Bind DLL3 on immune cells, reducing T-cell inhibition in the tumor microenvironment
B.
Bind DLL3 on tumor cells and CD3 on T-cells to promote tumor cell death
C.
Decrease tumor cell DLL3 expression to increase chemotherapy sensitivity
D.
Direct inhibition of DLL3-dependent Notch pathway signaling in tumor cells

Which of the following outcomes was reported from the phase II trial evaluating tarlatamab in patients with previously treated ES-SCLC?

A.
A median duration of response (DoR) of <6 months and modest rates of high-grade cytokine release syndrome (CRS)
B.
A median overall survival (OS) of >1 year with modest rates of low-grade CRS during step-up dosing
C.
Responses were reported only among patients with DLL3 expression ≥20%
D.
Poorer survival in patients with a shorter progression-free interval after first-line chemotherapy

Which of the following most accurately describes patients with SCLC who may be eligible for a clinical trial evaluating a DLL3-targeting T-cell engager therapy?

A.
Patients with previously treated ES-SCLC and high DLL3 tumor expression only
B.
Patients with either previously untreated or previously treated ES-SCLC and high DLL3 tumor expression only
C.
Patients with previously treated ES-SCLC regardless of DLL3 tumor expression
D.
Patients with either previously untreated or previously treated ES-SCLC regardless of DLL3 tumor expression
E.
Patients with either limited-stage (LS)-SCLC or ES-SCLC regardless of DLL3 tumor expression

For those providing patient care, what is your current preferred therapy for patients with ES-SCLC who have progressive disease after frontline platinum-based chemotherapy?

A.
Retreatment with platinum/etoposide
B.
Irinotecan
C.
Lurbinectedin
D.
Tarlatamab
E.
Topotecan
F.
Other

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Future Applications in ES-SCLC: Targeting DLL3 and Emerging Evidence for T-Cell Engagers

Carl M. Gay, MD, PhD

Activity