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This is a four-drug combination consisting of obrixtamig, carboplatin, etoposide, and atezolizumab, explored primarily for treatment of extensive-stage small cell lung cancer (ES-SCLC) and other neuroendocrine carcinomas. - **Obrixtamig** is a bispecific T-cell engager antibody targeting both delta-like ligand 3 (DLL3) on tumor cells and CD3 on T cells, facilitating immune-mediated lysis of DLL3-expressing tumor cells, particularly aggressive neuroendocrine tumors such as small cell lung cancer, large-cell neuroendocrine carcinoma, and extrapulmonary neuroendocrine carcinoma. - **Carboplatin** is a platinum-based cytotoxic chemotherapy agent that induces DNA crosslinks, leading to cell death in rapidly dividing cancer cells. - **Etoposide** is a topoisomerase II inhibitor, causing DNA damage and apoptosis in proliferating cells. - **Atezolizumab** is a humanized monoclonal IgG1 antibody that blocks PD-L1, preventing its interaction with PD-1 and B7.1, reactivating cytotoxic T cells against tumor cells. This combination is mechanistically synergistic, combining immune targeting (obrixtamig, atezolizumab) with cytotoxic chemotherapy (carboplatin, etoposide). Obrixtamig is in clinical development for neuroendocrine cancers, and the backbone of carboplatin/etoposide/atezolizumab is standard of care for ES-SCLC. Obrixtamig is developed by Boehringer Ingelheim; atezolizumab is developed and marketed as Tecentriq by Genentech/Roche.
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