Abstract CN54
Background
Tyrosine kinase inhibitors (TKIs) remains a cornerstone of metastatic kidney cancer (mRCC) treatment as a monotherapy or in combination with IO agents. However, TKI are associated with occurrence of adverse events (AEs) leading to common dose interruptions and reductions. Maintaining an efficient dose-intensity (DI) requires optimal management of adverse events of TKIs AEs. The aim of our study was to evaluate the impact of an app-based and nurse-led supportive care program on DI in mRCC patients.
Methods
We performed a multicenter (n=3), retrospective study of all consecutive mRCC patients who participated in the AKO@dom program. This program is based on an app-based and nurse-led weekly patients evaluation at home during the first 3 months of TKI intake. Treatment patterns and modifications were described, and the mean DI (mDI) was calculated at the end of the supportive care program.
Results
A total of 89 patients were included: 12 treated with Sunitinib, 18 with Pazopanib, 12 with Axitinib and 47 with Cabozantinib. The median age was 69 years [60-76]. The majority (71%) had prior systemic treatment for mRCC. The TKIs were mainly initiated at standard doses except in the Cabozantinib group (53% started at 40mg/day). Nine patients discontinued permanently treatment during the program. Thirty-two patients required ≥1 dose interruption, and 29% experienced ≥1 grade 3 AE of any type. The mDI (in mg/day) at 3 months was 34.4±17.7 for Sunitinib, 672.8±144 for Pazopanib, 8.6±2.6 for Axitinib, and 40 [36-48] for Cabozantinib. Overall, 55 patients [68.75% (95% CI: 57-78%)] had a mDI equal to or greater than the mDI reported in the literature, thus demonstrating the benefit of the AKO@dom program compared to standard follow-up. Overall survival at 12 months was 64,2% (CI 95%: 55-75%).
Conclusions
In our cohort, the app-based and nurse-led AKO@dom program allowed more than two-thirds of patients to maintain a high dose-intensity after 3 months of TKI treatment. The impact of this supportive care program on survival outcomes still needs to be evaluated in randomized clinical trials.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.