Would you consider delaying Tarlatamab initiation in a patient with ES SCLC who recently completed RT for CNS disease, given the concern for immune effector cell-associated neurotoxicity syndrome (ICANS)?  

I would not delay beyond what we already do for other systemic treatments. We tend to wait at least a week or more after whole brain RT and systemic therapy of any nature. I do not think this is any different.

This is a good question and an important concern. This largely depends on the type of radiation (whole brain versus stereotactic radiosurgery), the size of the brain metastases treated, and the time from radiotherapy to treatment (given the risk for possible radiation necrosis, which is a confounder...