A new study is lending critical insights into patient perspectives on treatment-related toxicities and therapeutic drug monitoring with tyrosine kinase inhibitors (TKIs) for the treatment of non-small-cell lung cancer (NSCLC).
Judith Gulikers, a PhD student affiliated with the Maastricht University Medical Centre, The Netherlands CARIM School for Cardiovascular Disease, and Maastricht University, and colleagues conducted the study and published the findings in Therapeutic Advances in Medical Oncology.
It was important to conduct the research because TKIs are “usually well tolerated and used for a prolonged time, although experienced toxicity varies between patients,” and it is “unclear whether patients report all (low grade) toxicities and how these impact their daily lives.”
The use of therapeutic drug monitoring to manage toxicities “is increasingly applied, but there is limited insight into the patient perspective” on this approach. The researchers aimed to address the knowledge gap on the topic by conducting a qualitative study to explore patient perspectives on TKI toxicity and therapeutic drug monitoring.
The researchers conducted five semi-structured focus group interviews. Each group included three to four patients with NSCLC who were receiving treatment with TKI and their care partners, for a total of 16 patients and 12 care partners. In addition, two researchers independently performed a directive content analysis.
The qualitative study showed that patients had limited encounters with experiencing treatment-related toxicities and “felt no boundaries discussing these with their treatment team,” the researchers explained.
“However, symptoms were sometimes not reported as they were doubted as treatment related. The concept of [therapeutic drug monitoring]-guided dosing to, for example, reduce TKI exposure to account for dosing outside the therapeutic window resulted in feelings of uncertainty regarding treatment efficacy,” the researchers explained. “Patients emphasized the need for thorough research and frequent check-ups to ensure treatment efficacy.”
Based on these findings, the study authors emphasized that even when “perceived TKI-related toxicities seem limited,” it’s still important for the “treatment team should pay attention to symptoms not directly described by patients as treatment related.”
The investigators concluded that patients are generally open to implementing therapeutic drug monitoring-guided dosing, but “only if thorough scientific evidence demonstrates retained or enhanced safety and efficacy.”
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