Lung cancer (Amsterdam, Netherlands) · 2026
Concomitant medications and outcomes of bispecific T-cell engager therapy: A propensity-matched study of tarlatamab in ES-SCLC.
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Eysha Mostafa, Green Alexis, Khamis Mohamed M, Arai Momo, McKenzie Brock, Black Mariah, Zaki Islam Hamza, Zhang Bingnan, Clarke Jeffrey M, DeVito Nicholas C, Alder Laura
Аннотация
BACKGROUND: Tarlatamab, a bispecific T-cell engager (BiTE), has shown efficacy in extensive-stage small cell lung cancer (ES-SCLC). However, the impact of concomitant medications on treatment outcomes remains unknown. We evaluated the association between commonly prescribed medications and survival and toxicities in patients receiving tarlatamab.
METHODS: We conducted a retrospective cohort study using TriNetX between April 2024 and May 2026. Lung cancer patients on tarlatamab were stratified according to exposure to concomitant medications within 3 months before or after treatment initiation. The primary endpoint was overall survival (OS), while secondary endpoints were cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS). One-to-one propensity score matching was performed for demographics, comorbidities, disease characteristics, prior therapies, and the remaining nine medication classes.
RESULTS: Among ten propensity-matched comparisons, cohort sizes ranged from 112 to 229 per arm, with mean patient age from 65 to 68 years. Five medication classes were associated with significantly worse OS: antibiotics (HR 3.20, CI 2.12-4.84), opioids (HR 2.84, CI 1.71-4.70), acetaminophen (HR 2.26, CI 1.23-4.14), glucocorticosteroids (HR 2.14, CI 1.30-3.52), and benzodiazepines (HR 1.55, CI 1.06-2.27). No medication class significantly affected ICANS.
CONCLUSIONS: Several commonly used medications were associated with inferior survival in patients receiving tarlatamab for ES-SCLC. Although residual confounding cannot be excluded, these findings support prospective investigation of concomitant medication use during BiTE therapy.
METHODS: We conducted a retrospective cohort study using TriNetX between April 2024 and May 2026. Lung cancer patients on tarlatamab were stratified according to exposure to concomitant medications within 3 months before or after treatment initiation. The primary endpoint was overall survival (OS), while secondary endpoints were cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS). One-to-one propensity score matching was performed for demographics, comorbidities, disease characteristics, prior therapies, and the remaining nine medication classes.
RESULTS: Among ten propensity-matched comparisons, cohort sizes ranged from 112 to 229 per arm, with mean patient age from 65 to 68 years. Five medication classes were associated with significantly worse OS: antibiotics (HR 3.20, CI 2.12-4.84), opioids (HR 2.84, CI 1.71-4.70), acetaminophen (HR 2.26, CI 1.23-4.14), glucocorticosteroids (HR 2.14, CI 1.30-3.52), and benzodiazepines (HR 1.55, CI 1.06-2.27). No medication class significantly affected ICANS.
CONCLUSIONS: Several commonly used medications were associated with inferior survival in patients receiving tarlatamab for ES-SCLC. Although residual confounding cannot be excluded, these findings support prospective investigation of concomitant medication use during BiTE therapy.