{
  "case_id": "ICSR-001",
  "study_drug": "Tarlatamab",
  "drug_class": "DLL3 T-cell engager (BiTE)",
  "patient": {
    "age": 64,
    "sex": "M",
    "comorbidities": [
      "ES-SCLC, 2nd line",
      "former smoker"
    ],
    "concomitant_meds": [
      "dexamethasone premedication",
      "ondansetron"
    ]
  },
  "narrative": "64-year-old man with extensive-stage small cell lung cancer received his first step-up dose of the DLL3 T-cell engager. Approximately 8 hours after dosing he developed fever to 39.2C with rigors and low blood pressure (88/54) requiring IV fluids; this was graded as cytokine release syndrome. On day 2 nursing noted he was confused with a coarse tremor and a drop in his ICE score (neurotoxicity). He was admitted to hospital and treated with tocilizumab and steroids; symptoms resolved over 48 hours. He was re-dosed at the next cycle with premedication and had only mild recurrence. No infection was identified on workup.",
  "events": [
    "fever with low blood pressure (CRS)",
    "confusion with tremor (neurotoxicity)"
  ]
}

{
  "drug_class": "DLL3 T-cell engager (BiTE)",
  "examples": [
    "Tarlatamab"
  ],
  "labeled": [
    "Cytokine release syndrome",
    "Immune effector cell-associated neurotoxicity syndrome",
    "Pyrexia",
    "Neutropenia",
    "Anaemia",
    "Fatigue",
    "Hypotension"
  ],
  "boxed_warning": "Cytokine release syndrome and neurologic toxicity including ICANS.",
  "note": "CRS and ICANS are expected, very common, on-target effects of T-cell engagers; typically occur within days of the first/step-up doses."
}

{
  "query": "cytokine release syndrome",
  "count": 1,
  "matches": [
    {
      "pt": "Cytokine release syndrome",
      "soc": "Immune system disorders",
      "synonyms": [
        "crs",
        "cytokine storm",
        "infusion cytokine reaction"
      ]
    }
  ]
}

{
  "query": "fever",
  "count": 2,
  "matches": [
    {
      "pt": "Febrile neutropenia",
      "soc": "Blood and lymphatic system disorders",
      "synonyms": [
        "fever with low white count",
        "neutropenic fever"
      ]
    },
    {
      "pt": "Pyrexia",
      "soc": "General disorders and administration site conditions",
      "synonyms": [
        "fever",
        "high temperature",
        "febrile",
        "raised temperature"
      ]
    }
  ]
}

{
  "query": "low blood pressure",
  "count": 1,
  "matches": [
    {
      "pt": "Hypotension",
      "soc": "Vascular disorders",
      "synonyms": [
        "low blood pressure",
        "low bp"
      ]
    }
  ]
}

{
  "query": "rigors",
  "count": 0,
  "matches": []
}

{
  "query": "confusion",
  "count": 1,
  "matches": [
    {
      "pt": "Immune effector cell-associated neurotoxicity syndrome",
      "soc": "Nervous system disorders",
      "synonyms": [
        "icans",
        "neurotoxicity",
        "neurologic toxicity",
        "confusion with tremor",
        "encephalopathy",
        "ice score drop"
      ]
    }
  ]
}

{
  "query": "tremor",
  "count": 1,
  "matches": [
    {
      "pt": "Immune effector cell-associated neurotoxicity syndrome",
      "soc": "Nervous system disorders",
      "synonyms": [
        "icans",
        "neurotoxicity",
        "neurologic toxicity",
        "confusion with tremor",
        "encephalopathy",
        "ice score drop"
      ]
    }
  ]
}

{
  "query": "neurotoxicity",
  "count": 1,
  "matches": [
    {
      "pt": "Immune effector cell-associated neurotoxicity syndrome",
      "soc": "Nervous system disorders",
      "synonyms": [
        "icans",
        "neurotoxicity",
        "neurologic toxicity",
        "confusion with tremor",
        "encephalopathy",
        "ice score drop"
      ]
    }
  ]
}

{
  "query": "chills",
  "count": 0,
  "matches": []
}