Application of the remote therapeutic monitoring (RTM) platform to optimize adherence and manage toxicity of oral anti-cancer medications (OAM).

594 Background: OAM make up more than 1/3 of all systemic cancer therapies, but adherence declines over time. Optimizing adherence and managing toxicities can be challenging, as patients are seen less often than with parenteral therapy. ASCO/NCODA have published standards for medically-integrated pharmacies (MIP). We report on the feasibility of using the Canopy remote therapeutic monitoring (RTM) platform to monitor and manage toxicities of OAM. Methods: 250 patients at 5 oncology practices with MIPs were invited to enroll in the Canopy ePRO-based RTM system. Patients were asked to report treatment adherence weekly, as well as toxicities. Practices defined notification thresholds for deviation from optimal adherence and symptom severity, and contacted patients via telephone when these thresholds were exceeded. Results: 250 patients were enrolled in RTM and submitted at least one report. The median patient age was 70, 43% were women, and the majority were white. The most common diagnoses were CLL, lymphoma, breast cancer, and colorectal cancer. The most frequent oral oncolytic drug classes were BTKi, antimetabolites, and ImIDs. At data cutoff, the median time enrolled in the RTM program during treatment was 73 days, and patients submitted a median of 8 reports. 10% of patients reported a change in other medications/supplements. 68% reported no missed doses, and 16% reported 3 or more missed doses. The top causes for missing a dose were forgetting, clinical instruction to skip the dose, and issues filling prescriptions; 26% of those who reported a missed dose were contacted following a report of missing a dose. The most common symptoms reported were weakness/fatigue, infection, and pain; 47% of patients were contacted following an RTM report, most commonly due to weakness/fatigue and pain. Conclusions: The use of an RTM platform for patients to report adherence and toxicity to OAM is feasible in the community setting, and program expansion is actively underway. Although many patients can adhere to the prescribed treatment regimen, a significant portion of patients missed more than three doses. Toxicity reporting is similar to that in studies of patients receiving parenteral anti-cancer therapy. This proprietary RTM platform allows practices to fulfill or exceed ASCO/NCODA oral anti-cancer standards for a MIP, leveraging technology to facilitate OAM management as opposed to relying on a manual, phone-based approach.