{"entity":{"id":"tarlatamab-vs-idxd-sequence","kind":"pairing","name":"Sequencing DLL3 engager and B7-H3 ADC in relapsed SCLC","aka":[],"tldr":"Two new relapsed-disease options with different targets and mechanisms. Which comes first, and whether one works after the other, is unknown.","summary":"This sequencing question in relapsed small-cell lung cancer concerns tarlatamab, a DLL3-directed T-cell engager, and ifinatamab deruxtecan (I-DXd), a B7-H3-directed antibody-drug conjugate with a topoisomerase 1 payload. Tarlatamab has shown a survival benefit in DeLLphi-304, while I-DXd has produced high response rates and is in the phase 3 IDeate-Lung02 trial. Because the two drugs hit different antigens and kill by different mechanisms, they are expected not to be cross-resistant, and their toxicity profiles also differ, cytokine release syndrome for one and interstitial lung disease and neutropenia for the other, which could allow a patient-based choice. No prospective data yet say which should come first or whether one works after the other, so the pairing remains a concept.","asOf":"2026-09-07","links":[],"tags":[],"related":[],"cancers":["sclc"],"sections":[],"technologies":[],"targets":["dll3","b7h3"],"drugs":["tarlatamab","ifinatamab-deruxtecan"],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"a":"tarlatamab","b":"ifinatamab-deruxtecan","rationale":"Distinct targets and killing mechanisms; toxicity profiles (CRS vs ILD/neutropenia) also differ, allowing patient-based choice.","evidence":"No prospective sequencing data; concept.","pairingType":"sequence"},"route":"/pairings/tarlatamab-vs-idxd-sequence/","neighbours":{"cancer":[{"id":"extensive-stage-sclc","kind":"cancer","name":"Extensive-stage small-cell lung cancer","route":"/cancers/extensive-stage-sclc/"},{"id":"sclc","kind":"cancer","name":"Small-cell lung cancer","route":"/cancers/sclc/"}],"target":[{"id":"b7h3","kind":"target","name":"B7-H3","route":"/targets/b7h3/"},{"id":"dll3","kind":"target","name":"DLL3","route":"/targets/dll3/"}],"drug":[{"id":"ifinatamab-deruxtecan","kind":"drug","name":"Ifinatamab deruxtecan","route":"/drugs/ifinatamab-deruxtecan/"},{"id":"tarlatamab","kind":"drug","name":"Tarlatamab","route":"/drugs/tarlatamab/"}]}}