Impact of the app-based and nurse-led supportive care program AKO@dom on dose intensity of oral-targeted therapies in patients with metastatic renal cell cancer: a multicentric observational retrospective study

Background Tyrosine kinase inhibitors (TKIs) remain a cornerstone of metastatic kidney cancer (mRCC). Adverse events (AEs) may lead to dose downregulation, and optimal management of AEs is needed to maintain an efficient dose intensity (DI). The aim of our study was to evaluate the impact of an app-...

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Published in:Supportive care in cancer Vol. 30; no. 8; pp. 6583 - 6591
Main Authors: Gaillard, Victor, Lhuillier, Albane, Bigot, Cécile, Pierard, Laure, Trensz, Philippe, Burgy, Mickael, Schuster, Caroline, Malouf, Gabriel, Fritsch, Aurélie, Lang, Hervé, Tricard, Thibault, Borchiellini, Delphine, Geoffrois, Lionnel, Barthelemy, Philippe
Format: Journal Article
Language:English
Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.08.2022
Springer
Springer Nature B.V
Subjects:
Antimitotic agents
Antineoplastic agents
Cancer
Care and treatment
Chemotherapy
Clinical research
Clinical trials
Complications and side effects
Critical incidents
Discontinued
Dosage
Drug dosages
Elementary school students
Inhibitor drugs
Kidney cancer
Medical personnel
Medical treatment
Medicine
Medicine & Public Health
Metastasis
Nurse led services
Nurses
Nursing
Nursing care
Nursing Research
Oncology
Oncology, Experimental
Oral administration
Original Article
Pain Medicine
Palliative care
Patients
Rehabilitation Medicine
Side effects
Targeted cancer therapy
App-based program
TKI
Supportive care program
Nurse-led program
Kidney cancer
ISSN:0941-4355, 1433-7339, 1433-7339
Online Access:Get full text
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Summary:Background Tyrosine kinase inhibitors (TKIs) remain a cornerstone of metastatic kidney cancer (mRCC). Adverse events (AEs) may lead to dose downregulation, and optimal management of AEs is needed to maintain an efficient dose intensity (DI). 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. Method This multicenter ( n  = 3), retrospective study evaluated all consecutive mRCC patients who participated in the AKO@dom program, which consisted of an app-based and nurse-led weekly patient 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 AKO@dom. Results Eighty-nine patients were included: 12 had sunitinib, 18 pazopanib, 12 axitinib, and 47 cabozantinib. Median age was 69 years (60–76). TKIs were mainly initiated at standard doses except for cabozantinib (53% started at 40 mg/day); 71% had prior systemic treatment. Nine patients discontinued permanent 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. Fifty-five patients [68.75% (95% CI: 57–78%)] had a mDI ≥ than reported in the literature. Overall survival at 12 months was 64.2% (CI 95%: 55–75%). Conclusion The AKO@dom program allowed 68.75% of patients to maintain a high dose intensity after 3 months of TKI treatment. The impact on survival outcomes needs to be evaluated in randomized clinical trials.
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ISSN:0941-4355
1433-7339
1433-7339
DOI:10.1007/s00520-022-07088-1