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Case Reports
. 2024 Oct 19;5(12):100750.
doi: 10.1016/j.jtocrr.2024.100750. eCollection 2024 Dec.

First Report of Response to Tarlatamab in a Patient With DLL3-Positive Pulmonary Carcinoid: Case Report

Alissa J Cooper  1 , Natasha Rekhtman  2 , Marina K Baine  2 , Marie C Thomas  3 , Alia C Lynch  3 , Ryan D Gentzler  4
Affiliations
Case Reports

First Report of Response to Tarlatamab in a Patient With DLL3-Positive Pulmonary Carcinoid: Case Report

Alissa J Cooper et al. JTO Clin Res Rep. .

Abstract

Tarlatamab, a DLL3-targeting bispecific T-cell engager, has rapidly assumed the role of a new standard of care in the later-line treatment of extensive-stage SCLC. Little is known about the efficacy of tarlatamab in other histologies such as DLL3-expressing metastatic pulmonary carcinoid tumor, a clinical entity without many approved management options. Here, we report the case of a patient with metastatic atypical carcinoid tumor which had progressed on multiple previous therapies. Her tumor strongly expressed DLL3 protein and had clinical response to tarlatamab therapy. This case indicates that this novel therapy may be an efficacious option in other pulmonary neuroendocrine cancers.

Keywords: Carcinoid; Case report; Neuroendocrine; Tarlatamab.

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Conflict of interest statement

Dr. Cooper reports the following conflicts of interest for the previous 3 years: receiving honoraria from MJH Life Sciences, Ideology Health, Intellisphere LLC, and MedStar Health, and consulting fees from 10.13039/100005564Gilead Sciences, Inc., and Regeneron. She reports receiving research funding to institution from Merck, Monte Rosa, AbbVie, Roche, and Amgen. Dr. Rekhtman reports the following conflicts of interest for the previous 3 years: receiving consulting fees from 10.13039/100004334Merck. Ms. Thomas reports the following conflicts of interest for the previous 3 years: receiving honoraria from MD Outlook. Ms. Lynch reports the following conflicts of interest for the previous 3 years: receiving honoraria from MJH Life Sciences and PrecisionAQ; consulting fees from 10.13039/501100022274Daiichi Sankyo. Dr. Gentzler reports the following conflicts of interest for the previous 3 years: receiving research funding to institution from Pfizer, Tempus, Nalo Therapeutics, Puma, Mirati, Bristol Myers Squibb, Dizal, Chugai, Amgen, AstraZeneca, Janssen, Daiichi Sankyo, Jounce Therapeutics, Takeda, Merck, Alliance Foundation, ECOG/ACRIN, NCI, Big Ten Research Consortium, Hoosier Cancer Research Network, and SWOG; receiving honoraria from Academy for Continued Healthcare Learning, Curio, OncLive, Aptitude Health, MedStar Health, Clinical Care Options, and American Society of Clinical Oncology; receiving travel support to meetings from Dava Oncology, Tempus, American Society of Clinical Oncology (ASCO), and International Association for the Study of Lung Cancer (IASLC); receiving consulting fees from 10.13039/100002429Amgen, 10.13039/100004328Genentech, 10.13039/100004325AstraZeneca, 10.13039/100009857Regeneron, Merus, Takeda, Gilead, Janssen, Mirati, and Daiichi Sankyo; and having leadership roles with Hoosier Cancer Research Network, ASCO, Journal of Clinical Oncology, NCI Investigational Drug Steering Committee, and IASLC Conference Planning Committees. Baine declares no conflicts of interest.

Figures

Figure 1
Figure 1
Diagnostic and treatment timeline. CNS, central nervous system; CT, computed tomography; LAR, long-acting repeatable; MRI, magnetic resonance imaging; PET, positron emission tomography; RT, radiation therapy; SRS, stereotactic radiosurgery; SUV, standard uptake value.
Figure 2
Figure 2
Histopathology and DLL3 expression. (A) Hematoxylin and eosin of the endobronchial biopsy reveals a nested tumor with moderate granular cytoplasm, minimal cytologic atypia, and neuroendocrine features. (B) The tumor expresses chromogranin A and (C) has a Ki-67 proliferative index of 30%, consistent with the diagnosis of atypical carcinoid. (D) DLL3 reveals strong and diffuse membranous and cytoplasmic expression.
Figure 3
Figure 3
Baseline, 6-week, and 12-week imaging of key lesions revealing response. (A) Baseline, CT component of PET/Dotatate, enlarged left axillary lymph nodes; (B) baseline, CT abdomen, left adrenal metastasis; (C) 6 weeks, CT chest, left axillary node; (D) 6 weeks, CT abdomen, left adrenal metastasis; (E) 12 weeks, CT component of PET/Dotatate, left axillary lymph nodes; (F) 12 weeks, CT component of PET/Dotatate, left adrenal metastasis. CT, computed tomography; PET, positron emission tomography.
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