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药物政策：- Imdelltra™ (tarlatamab-dlle)
该药物的使用必须有以下之一的支持：FDA 批准的产品标签、CMS 批准的药典、国家综合癌症网络 (NCCN)、美国临床肿瘤学会 (ASCO) 临床指南，或符合 CMS 医疗保险福利政策手册第 15 章要求的同行评审文献。
细胞因子释放综合征（CRS）和神经毒性
细胞因子释放综合征（CRS）：Imdelltra™可能会引起CRS，包括严重或威胁生命的反应。在合并的安全人群中，CRS发生在55％的接受IMDELLTRA™的患者中，包括34％的1级，19％2级，1.1％3级和0.5％4级。反复发作的CR发生在24％的患者中，包括18％的1级和6％的2级。大多数事件（43％）发生在第一次剂量后发生，第二剂剂量后，有29％的患者患有任何级别的CR，而在第三剂量后或更高版本后患有CRS的患者中有9％。在第1天，第8天和第15天输注之后，分别经历了≥2级CR的患者的16％，4.3％和2.1％。最新剂量IMDELLTRA™的所有级别CR的中位时间为13.5小时（范围：1至268小时）。最新剂量IMDELLTRA™的≥2级CR的中位时间为14.6小时（范围：2至566小时）。CRS的临床体征和症状包括发热，低血压，疲劳，心动过速，头痛，缺氧，恶心和呕吐。CRS的潜在威胁生命并发症可能包括心脏功能障碍，急性呼吸窘迫综合征，神经系统毒性，肾脏和/或肝功能衰竭以及传播血管内凝结（DIC）。按照建议的加速剂量进行管理IMDELLTRA™，并在第1周期前后服用伴随药物IMDELLTRA™输注液，如处方信息（PI）的表3所述，以降低CRS的风险。在适当的医疗机构中管理Imdelltra™，该机构配备了监视和管理CRS。确保在服用IMDELLTRA™之前对患者进行水分充足。
专科医疗福利药品清单
Antineoplastic agents Abraxane, Adcetris, Adstiladrin, Alimta, Aliqopa, Alymsys, Anktiva, Arzerra, Asparlas, Avastin, Avzivi, Azedra, Beleodac, Belrapzo, Bendeca, Besponsa, Blenrep, Blincyto, Columvy, Cyram, Darzale, Darzale, Esa, Esa, Fax antibiotic, Elrexfio, Elzonris, Empliciti, Enhertu, Epkinly, Erbitux, Erwinaze, Faslodex, Firmagon, Folotyn, Gazyva, Halaven, Hepzato Kit, Herceptin, Herceptin Hylecta, Hercessi, Herzuma, Imdelltra, Imjudo, Imlygic, Instoron-A, Jelato, Jelato, Jena, Kanjinti, Khapzory, Kimmtrak, Kyprolis, Lunsumio, Margenza, Monjuvi, Mvasi, Mylotarg, Ogivri, Oncaspar, Ontruzant, Opdualag, Padcev, Pemfexy, Pemrydi RTU, Perjeta, Phesgo, Pluvicto, Polivy, Portrazza, Potelige, Provence, Hyundai, Hyundai, Rioxila , Rybrevant, Rylaze, Sarclisa, Synribo, Talvey, Tecvayli, Temodar, Tivdak, Trazimera, Treanda, Trodelvy, Truxima, Vegzelma, Vivimusta, Vyxeos, Xofigo, Yervoy, Zepzelca, Zevalin, Zirabev, Zynlonta >
专科医疗福利药品清单
Antineoplastic Agents Abraxane, Adcetris, Adstiladrin, Alimta, Aliqopa, Alymsys, Anktiva, Arzerra, Asparlas, Avastin, Avzivi, Azedra, Beleodaq, Belrapzo, Bendeca, Besponsa, Blenrep, Blincyto, Columvi, Cyramza, Danxel, Darzale, Elzale, Elzala, Eprozahere rexfio, Elzonris, Empliciti, Enhertu, Epkinly, Erbitux, Erwinaze, Faslodex, Firmagon, Folotyn, Gazyva, Halaven, Hepzato Kit, Herceptin, Herceptin Hylecta, Hercessi, Herzuma, Imdelltra, Imjudo, Imlygic, Intron-A, Istomy, Jela, Jel, Katjin, Khapzory, Kimmtrak, Kyprolis, Lunsumio, Margenza, Monjuvi, Mvasi, Mylotarg, Ogivri, Oncaspar, Ontruzant, Opdualag, Padcev, Pemfexy, Pemrydi RTU, Perjeta, Phesgo, Pluvicto, Polivy, Portrazza, Poteligeo, Provence, Rioxila, Hyunce, Rtu Rix vant, Rylaze, Sarclisa, Synribo, Talvey, Tecvayli, Temodar, Tivdak, Trazimera, Treanda, Trodelvy, Truxima, Vegzelma, Vivimusta, Vyxeos, Xofigo, Yervoy, Zepzelca, Zevalin, Zirabev, Zynlonta
输液疗法市场更新
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761344orig1s000 -AccessData.fda.gov
表48。Applicant – Subject Incidence of Serious Treatment-emergent Adverse Events by System Organ Class and Preferred Term for > 1% of Subjects Overall (Safety Analysis Set) (Study 20200491 Primary Analysis) ....................................................................................................... 209 Table 49.申请人 - 首选术语的严重不良事件（总体至少发生在1％的受试者中） - 单一疗法 - 研究20200491、20200040和单一疗法研究20160323（安全分析集）（安全分析集）90天安全更新........FDA Analysis of Serious Adverse Events ≥3% .............................................................. 212 Table 51.申请人 - 不良事件，导致塔拉塔马布通过首选术语（至少在2个受试者中发生） - 单一疗法 - 研究20200491，20200040和单一疗法研究20160323（安全分析集）（安全分析集）申请人 - 不良事件，导致塔拉塔马州通过首选期限（至少在2个主题中发生） - 单一疗法 - 研究20200491、20200040和单一疗法研究20160323（安全分析集）（安全分析集）90天安全更新... 215表53。Applicant – Summary of Adverse Events – Monotherapy – Studies 20200491, 20200040 and Monotherapy Cohorts of Study 20160323 (Safety Analysis Set) ....................... 221 Table 54.Applicant – Adverse Reactions (≥ 15%) in Subjects with SCLC Who Received Tarlatamab 10 mg in Study 20200491 a ....................................................................................... 222 Table 55.Applicant – Summary of Adverse Events – Monotherapy – Studies 20200491, 20200040 and Monotherapy Cohorts of Study 20160323 (Safety Analysis Set) 90-Day Safety Update......................................................................................................................................... 224 Table 56 FDA Analysis of Select Laboratory Abnormalities (≥ 20%) That Worsened from Baseline in Patients with ES - SCLC in Study DeLLphi-300 and Study DeLLphi-301 .................................. 228 Table 57 FDA Analysis of CRS and neurologic toxicity, including ICANS .................................... 238 Table 58.Analysis of Adverse Events by Sex .............................................................................. 242 Table 59.按年龄组分析不良事件............................................................................................................................................................................................................................................................................................................................................................... 242表60。分析种族的不良事件..................................................................................................................................................................................................................................................................................................................................... 243表61推荐的剂量和imdelltra（tarlatamab）的时间表（Tarlatamab） - 拟议的标签257表62咬合分子中CRS和ICAN的风险缓解和ICAS的发生率 ..................................................................................................................................................... 258 Table 63.Summary of Tarlatamab PK geometric mean (CV%) following IV administration of Tarlatamab in Cycle 2 (Study 20160323) .................................................................................... 277 Table 64.在研究20200491中，静脉注射10 mg或100mg Q2W方案后，静脉注射10 mg或100mg Q2W方案后，几何平均值（CV％）塔拉氏症峰和槽血清浓度摘要。..................................................................................................................... 279 Table 65 Summary of Demographics, Clinical Characteristics and Baseline Covariates ............ 292 Table 66 Parameter Estimates for the Final Model .................................................................... 294 Table 67 Bootstrap Estimates and 95% Confidence Intervals .................................................... 295 Table 68 Pharmacokinetic Parameters of Tarlatamab 1/10 mg Q2W in Patients with SCLC in Study 20200491.......................................................................................................................... 301 Table 69 Exposure comparison between the Applicant's proposed retreatment plan after dose delay and the treatment plan with no dose delay ..................................................................... 302