How a Team Implemented Outpatient Administration of Tarlatamab for SCLC

Jennifer Carlisle, MD, of the Winship Cancer Institute of Emory University, joined Lung Cancers Today to share insights from her institution’s experience with outpatient administration of the bispecific T-cell engager tarlatamab.

Dr. Carlisle, who presented on the outpatient administration program during the 2025 American Society of Clinical Oncology (ASCO) Annual Meeting, explained how the program was implemented at Emory University.

The program primarily involves the outpatient administration of the bispecific T-cell engager at the institution’s immediate care center, a 24-hour clinic led by advanced practice providers (APPs).

“That lets us safely do the 24-hour monitoring that is on the FDA label for tarlatamab without necessarily admitting patients who end up not needing to be admitted,” Dr. Carlisle explained.

There were multiple steps and stakeholders involved with the implementation process, she said.

“At Emory, our pharmacy, inpatient teams, the infusion center, and our immediate care center all had to sit at the table to discuss how we were going to coordinate administering the drug in the outpatient infusion center, monitoring the patient there for a short time, then transporting them to our ICC [immediate care center] for the remainder of monitoring,” Dr. Carlisle said.

The monitoring consisted of nurses checking patients’ vital signs and monitoring them for symptoms of immune effector cell-associated neurotoxicity syndrome (ICANS) and cytokine release syndrome (CRS).

“Patients who develop toxicity outside of a grade 1 CRS, anything more than a fever, are then subsequently admitted to the inpatient oncology service,” Dr. Carlisle said.

She explained that this approach has been helpful for “preserving beds for patients in the hospital who need them” and for avoiding inpatient admissions for patients who do not experience adverse effects.

“This required coordination with the outpatient and inpatient APPs and making sure providers are all educated on CRS and ICANS, and when to give extra dexamethasone or tocilizumab,” Dr. Carlisle said.

According to Dr. Carlisle, this type of outpatient administration program requires several key safety measures.

“One is for patients to have wallet cards. These are provided by the company, so should they end up in an outside emergency department, providers there can look up or familiarize themselves with what may be toxicities and safety measures to mitigate some of those toxicities,” Dr. Carlisle said. “We also provide our patients with a dose of oral dexamethasone to have on hand at home in case there are transportation issues or delays in being able to come to the center or somewhere for medical care.”

She also reflected on the important role of nurses and APPs throughout the entire process.

“We were able to successfully use advanced practice providers who are there 24/7 to provide the advanced level of care needed to make decisions in terms of who needs to be admitted,” Dr. Carlisle said. “There does need to be a clear pathway so nurses know who to call should a patient develop increased side effects. While in the majority of patients, CRS is grade 1 and mild, it can get very severe, and there has to be appropriate ICU-level of care that can be accessed expeditiously.”