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Sequencing DLL3 engager and B7-H3 ADC in relapsed SCLC

Two new relapsed-disease options with different targets and mechanisms. Which comes first, and whether one works after the other, is unknown.

Tarlatamab has a survival benefit (DeLLphi-304); I-DXd has high response rates and is in phase 3 (IDeate-Lung02). Different antigens (DLL3 vs B7-H3) and mechanisms (T-cell redirection vs TOP1 payload) suggest non-cross-resistance, but no sequencing data exist.

Rationale
Distinct targets and killing mechanisms; toxicity profiles (CRS vs ILD/neutropenia) also differ, allowing patient-based choice.
Evidence
No prospective sequencing data; concept.

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