Abstract 33P
Background
Peripheral edema (PE), a class effect of MET TKIs, can impact treatment (tx) adherence. We conducted the Powerhouse Insights from Virtual Oncology Therapeutic Specialists (PIVOTS) survey of physicians’ experience with MET TKIs to better understand associated PE and optimize its management.
Methods
An online survey assessed onset, time to resolution, symptoms, prevention, and management of PE during tx with four available MET TKIs for MET exon 14 skipping NSCLC (tepotinib, capmatinib, savolitinib and crizotinib).
Results
In total, 26 physicians participated: Asia (14), Europe (6), UK (2) and North America (4). 24 physicians had experience with tepotinib, 10 with savolitinib, 20 each with capmatinib and crizotinib, and 7 with all four MET TKIs. Six physicians had experience with >20 patients (pts), 9 with 10–20 pts, 6 with 5–10 pts and 5 with <5 pts treated with a MET-TKI. 77% of physicians reported that >50% of pts had PE with MET TKIs. Low mobility, age, and time on tx were reported as common risk factors, and cardiac disease as the most common comorbidity. PE onset, which may take >6 months, and time to improvement was considered similar among MET-specific TKIs, with crizotinib (a multi-kinase TKI) resulting in less frequent, less severe, and less durable PE. Swollen extremities were reported by 96% of physicians as the most bothersome symptom followed by pain (46%) and weight gain (31%), with a resolution time of up to 3 months in mild-moderate PE and up to 6 months in severe PE. Pain (81% vs 23%) and skin lesions (50% vs 23%) were reported as more common in severe vs mild-moderate PE, respectively. 62% of physicians incorporated multiple preventive measures simultaneously (bed/feet elevation [88%], compression stockings [69%], massage [63%], salt intake reduction [50%], exercise/diuretics [25%]); only 13% incorporated at tx initiation. The most common tx were diuretics (89%), non-pharmacologic measures (85%), MET TKI interruption (73%) and dose reduction (65%); 4/5 Chinese physicians reported consulting vascular specialists.
Conclusions
The PIVOTS survey indicates the most important unmet needs for PE management are developing effective tx, incorporating preventive measures at MET TKI initiation (not only at PE onset), and clarity of its mechanism of action associated with MET TKI.
Editorial acknowledgement
Medical writing assistance (funded by Merck Healthcare KGaA, Darmstadt, Germany) was provided by Pritha Bhunia of Syneos Health, London, UK.
Legal entity responsible for the study
Merck Healthcare KGaA, Darmstadt, Germany.
Funding
Merck Healthcare KGaA, Darmstadt, Germany (CrossRef Funder ID: 10.13039/100009945).
Disclosure
R. Ferrara: Non-Financial Interests, Personal, Advisory Board: Merck Sharp & Dohme, BeiGene. J.F. Vansteenkiste: Non-Financial Interests, Personal, Advisory Board: Merck Healthcare KGaA, Darmstadt, Germany. X. Yang: Non-Financial Interests, Personal, Other, Honoraria for lectures/advisory boards/consultancy: Bristol-Myers Squibb, Merck Sharp & Dohme, Roche, Novartis, AstraZeneca, BeiGene, HengRui, XinDa. F. Grossi: Non-Financial Interests, Personal, Other, Advisory Role/Ad Hoc Advisory Boards/Consultations (last 3 years): Eli Lilly, Roche, Boehringer Ingelheim, AstraZeneca, Pierre Fabre, Bristol-Myers Squibb, Merck Sharpe & Dohme, Novartis, Merck Healthcare KGaA, Darmstadt, Germany, Otsuka, Takeda, Bayer; Non-Financial Interests, Personal, Other, Honoraria: Seminar/Talks to Industry (last 3 years): Eli Lilly, Roche, Boehringer Ingelheim, AstraZeneca, Pierre Fabre, Amgen, Celgene, Bristol-Myers Squibb, Merck Sharpe & Dohme; Financial Interests, Personal, Research Grant: AstraZeneca, Bristol-Myers Squibb, Merck Sharp & Dohme. B. Melosky: Non-Financial Interests, Personal, Advisory Role: AstraZeneca, Takeda, Boehringer Ingelheim, Bristol-Myers Squibb, Merck Sharp & Dohme, Roche, EMD Serono, an affiliate of Merck KGaA, Pfizer. M. Ahn: Non-Financial Interests, Personal, Other, Consulting and advisory role: AstraZeneca, Eli Lilly, Amgen, Merck Healthcare KGaA, Darmstadt, Germany, Merck Sharpe & Dohme, Takeda, Ono, Pfizer, Yuhan, Alpha-pharmaceuticals, Daiichi Sankyo, Roche. A. Calles: Non-Financial Interests, Personal, Other, Consulting or advisory role: AstraZeneca, Boehringer Ingelheim, Pfizer, Roche/Genentech, Eli Lilly, Takeda, Novartis, Merck Sharp & Dohme, Bristol-Myers Squibb. O.S.H. Chan: Non-Financial Interests, Personal, Invited Speaker: Merck Sharp & Dohme, AstraZeneca, Novartis, Amgen, Merck Healthcare KGaA, Darmstadt, Germany; Non-Financial Interests, Personal, Advisory Board: Pfizer, Merck Healthcare KGaA, Darmstadt, Germany, Takeda, Janssen. R. Califano: Non-Financial Interests, Personal, Other, Consulting or advisory role: AstraZeneca, Sanofi, Pfizer, Roche, Eli Lilly, Takeda, Novartis, Merck Sharp & Dohme, Bristol-Myers Squibb, Janssen, PharmaMar, Amgen. K. Nishino: Non-Financial Interests, Personal, Other, Honoraria for lectures: Merck Healthcare KGaA, Darmstadt, Germany, AstraZeneca, Chugai pharmaceutical, Nippon Boehringer Ingelheim, Eli Lilly Japan, Roche Diagnostics, Novartis, Pfizer, Janssen Pharmaceutical K.K., Bristol Myers Squibb, Nippon Kayaku; Financial Interests, Personal, Research Grant: Ono Pharmaceutical Co., Ltd., Taiho Pharmaceutical Co., Ltd., Merck Sharp & Dohme, AbbVie, Daiichi Sankyo Company, Limited, Amgen, Eisai Co., Ltd., Sanofi K.K., Janssen Pharmaceutical K.K., Novartis, Pfizer, Merck Healthcare KGaA, Darmstadt, Germany, Takeda, Eli Lilly Japan, Chugai pharmaceutical, Merus. V. Ghori: Non-Financial Interests, Personal, Full or part-time Employment: Merck Healthcare KGaA, Darmstadt, Germany. P. Ronga: Non-Financial Interests, Personal, Full or part-time Employment: Merck Healthcare KGaA, Darmstadt, Germany. K. Berghoff: Non-Financial Interests, Personal, Full or part-time Employment: Merck Healthcare KGaA, Darmstadt, Germany. S. Vlassak: Non-Financial Interests, Personal, Full or part-time Employment: Merck N.V.-S.A., Belgium, an affiliate of Merck Healthcare KGaA, Darmstadt, Germany. X. Le: Non-Financial Interests, Personal, Other, Consulting/advisory role: Sanofi Aventis, Merck Sharp and Dohme, Takeda, Amgen, Boehringer Ingelheim. All other authors have declared no conflicts of interest.