Gulikers Judith, Bruinsma Jeroen, Schoenmaekers Janna, Dursun Safiye, Tjan-Heijnen Vivianne, van Geel Robin, Croes Sander, Hendriks Lizza
Department of Clinical Pharmacy & Toxicology, Maastricht University Medical Centre+, Maastricht, The Netherlands.
CARIM School for Cardiovascular Disease, Maastricht University, Maastricht, The Netherlands.
Ther Adv Med Oncol. 2024 Dec 7;16:17588359241303403. doi: 10.1177/17588359241303403. eCollection 2024.
Tyrosine kinase inhibitors (TKIs) have significantly improved treatment-related outcomes of patients with oncogene-driven non-small-cell lung cancer (NSCLC). TKIs are usually well tolerated and used for a prolonged time, although experienced toxicity varies between patients. It is unclear whether patients report all (low grade) toxicities and how these impact their daily lives. The use of therapeutic drug monitoring (TDM) to, for example, manage toxicities is increasingly applied, but there is limited insight into the patient perspective regarding TDM. This qualitative study aims to explore patient perspectives on TKI toxicity and TDM.
Five semi-structured focus group interviews were held, each with three to four patients with NSCLC using a TKI and their (care) partners. Two researchers independently performed a directive content analysis.
In total, 16 patients and 12 (care) partners participated. Experienced treatment-related toxicities were encountered limitedly and patients felt no boundaries discussing these with their treatment team. However, symptoms were sometimes not reported as they were doubted as treatment related. The concept of TDM-guided dosing to, for example, reduce TKI exposure to account for dosing outside the therapeutic window resulted in feelings of uncertainty regarding treatment efficacy. Patients emphasized the need for thorough research and frequent check-ups to ensure treatment efficacy.
Perceived TKI-related toxicities seem limited, although the treatment team should pay attention to symptoms not directly described by patients as treatment related. In general, patients are open to implement TDM-guided dosing, but only if thorough scientific evidence demonstrates retained or enhanced safety and efficacy.
酪氨酸激酶抑制剂（TKIs）显著改善了致癌基因驱动的非小细胞肺癌（NSCLC）患者的治疗相关结局。TKIs通常耐受性良好且使用时间较长，尽管患者之间的毒性反应存在差异。目前尚不清楚患者是否报告了所有（低级别）毒性反应以及这些反应如何影响他们的日常生活。治疗药物监测（TDM），例如用于管理毒性反应，应用越来越广泛，但对于患者对TDM的看法了解有限。这项定性研究旨在探讨患者对TKI毒性和TDM的看法。
进行了五次半结构化焦点小组访谈，每次访谈有三到四名使用TKI的NSCLC患者及其（护理）伙伴参加。两名研究人员独立进行了定向内容分析。
共有16名患者和12名（护理）伙伴参与。治疗相关毒性反应较少见，患者认为与治疗团队讨论这些问题没有障碍。然而，有时症状未被报告，因为怀疑与治疗有关。例如，TDM指导给药的概念，即减少TKI暴露以考虑治疗窗外给药，导致对治疗效果的不确定性。患者强调需要进行深入研究和频繁检查以确保治疗效果。
尽管治疗团队应关注患者未直接描述为与治疗相关的症状，但TKI相关毒性反应似乎有限。总体而言，患者愿意接受TDM指导给药，但前提是要有充分的科学证据证明安全性和疗效得以保留或提高。
