The effects of specialized сardio-oncological care on the duration of TKI therapy.

Abstract

e24030 Background: tyrosine kinase inhibitors (TKIs) often cause arterial hypertension (AH) that leads to dose reduction/withdrawal of them, but studies of effects on prognosis of goal blood pressure achievement are lacking. Methods: patients (n = 54, 78% men, median age 67 yrs) with metastatic renal cell carcinoma were divided into 2 groups before starting TKI treatment: in the control group, patients were observed during TKI-therapy by GP at local clinic, in the intervention group patients attended the cardio-oncological center (multicomponent antihypertensive therapy with rapid dose titration using telemedicine technologies). At the end of the study, the time to withdrawal/dose reduction of TKI (months) due to progression or intolerable toxicity, as well as overall survival (OS) and progression-free survival (PFS) in the groups were analyzed using the Kaplan-Mayer method and the median time to withdrawal/dose reduction of TKI/progression/death/ in the groups according to the Mann-Whitney criterion were compared in groups. Results: in the intervention group, 28 out of 38 patients stopped treatment with the prescribed TKI at the initial dose, the median time to TKI withdrawal was 9.7 months (95%CI = 4-15.5). During the study, 12 patients died, and the median OS was 15.8 months (95%CI = 0-38.2). Progression occurred in 23 patients, and the median PFS was 13.3 months (95%CI = 3.4-23.2). In the control group, 14 out of 16 patients stopped treatment with the prescribed TKI at the initial dose, the median time to TKI withdrawal was 2.7 months (95%CI = 1.3-4.1). During the study, 14 patients died, with a median OS of 9.8 months (95%CI = 7.6-12.1). Progression occurred in 11 patients, and the median PFS was 6.4 months (95% = 1.3-11.5). Statistically significant differences in the control and intervention groups according to the Mann-Whitney criterion were observed only in the time before the withdrawal of TKI (p = 0.001). Differences in OS and PFS were not statistically significant (p = 0.085 and p = 0.06, respectively). Conclusions: observation in cardio-oncological center has advantage over local clinics. The small sample size suggests further studies to assess the impact of specialized cardio-oncological care on prognosis with antiangiogenic therapy.