Nick Mulcahy

June 09, 2016

CHICAGO — A web-based application that prompts lung cancer patients to complete a symptom chart weekly on a smartphone, tablet, or computer improved overall survival by 7 months, compared with standard follow-up care, according to results from a prospective phase 3 trial from France.

The key to the intervention is that it allowed "earlier detection of relapse" and, thus, early supportive care in the study patients, 90% of whom had stage III or IV disease, and all of whom had received previous first-line chemotherapy, said Fabrice Denis, MD, PhD, from the Institut Inter-regional de Cancérologie Jean Bernard in Le Mans, France.

"Relapse does not occur during a planned visit," Dr Denis pointed out.

He spoke during a press conference here at the American Society of Clinical Oncology (ASCO) 2016 Annual Meeting.

Dr Denis explained that the technology automatically triggers an email alert to the physician (which leads to a clinic visit) upon the detection of any anomaly in the data stream from the patient.

Dr Fabrice Denis

This system a "tremendous advance," said Patricia Ganz, MD, a medical oncologist at the University of California, Los Angeles, who moderated the press conference.

"If we had a drug that provided this level of survival benefit, wouldn't we want to go out and use it?" she asked.

In a multi-institutional, randomized trial, 60 patients used the app, known as Moovcare (Sivan Innovation), and 61 patients — the control group — received standard care, which was clinical routine assessment with a CT scan every 3 to 6 months, or at the investigator's discretion.

Median overall survival was better in the app group than in the control group (19 vs 12 months). This translated into a 67% reduction in the relative risk for death (hazard ratio, 0.33; P = .0025).

The rate of 1-year overall survival was also better in the app group than in the control group (75% vs 49%); the absolute benefit was 26%. This was achieved despite the fact that the study was stopped early — at the planned 9-month interim analysis — because of positive benefit, and the control patients crossed over into the app group.

But the results need to be taken with a grain of salt, said study discussant Egbert Smit, MD, PhD, from the Netherlands Cancer Institute in Amsterdam.

The overall survival benefit was through delivery of appropriate treatment.

"We have to remember that the overall survival benefit was through delivery of appropriate treatment," Dr Smit explained.

At relapse, more patients in the app group than in the control group received optimal therapy (74% vs 33%; P < .001). The exact therapies used were not indicated in the study data, he noted.

The disparity in optimal therapy at time of relapse was a reflection of patients in the app group maintaining a better performance status, which, in turn, was a reflection of the efficiency of the app in expediting clinical care, Dr Denis explained.

Despite reservations, Dr Smit called the app a "simple and clever tool," and observed that there is no standard follow-up care after first-line therapy for lung cancer. He called for a confirmatory study.

This kind of "real-time interaction is already implemented at major centers," said David Carbone, MD, a lung cancer specialist at the Ohio State University Comprehensive Cancer Center–James Cancer Hospital in Columbus.

For example, at Ohio State, cancer patients can call a 24-hour-a-day hotline staffed by a triage nurse, who interviews the patient and decides whether or not to contact a physician. Dr Carbone said he believes that "talking to a person may be preferred."

The app, or similar technology, might be best when used in under-resourced settings and smaller practices, he told Medscape Medical News.

Dr Patricia Ganz

But Dr Ganz suggested that, in general, waiting for cancer patients to be forthcoming with their problems is not optimal.

"Systematically asking about things with a patient and asking them to respond [as the app does] is different than asking them, 'How are you today? Are you having any problems?' They won't volunteer it," she said.

The app requires that patients assess themselves weekly on 12 different measures, including asthenia, cough, dyspnea, and anorexia. Patients can also send a note through a text window.

Dr Gregory Masters

The fact that the app requires patients to actively report their symptoms or complications is important, said Gregory Masters, MD, a lung cancer specialist at Christiana Care's Helen Graham Cancer Center in Newark, Delaware, who served as an expert commentator at ASCO.

Lung cancer patients are often reticent about contacting their healthcare providers, he explained.

"Many of these patients have a lot of guilt about their diagnosis; we see that more in lung cancer patients than in many other patients," he said. "Some patients do not want to bother the doctor, the nurse, or the healthcare team with their symptoms, or they think they are not important."

During the press conference, Dr Masters pointed out that engaging patients is key to the outcome in this study, but is not exclusive to this specific app. "This study doesn't show it is the only way or the best way [to improve survival]."

Dr Denis did not take offense at the comment. "You will have the same results if you call patients every week by phone," he said.

It is not possible to follow many patients simultaneously [with the phone].

But that is impractical, he pointed out. "It is not possible to follow many patients simultaneously [with the phone]."

With the app, a clinician can spend 15 minutes a week following 60 patients, Dr Smit reported.

The benefits of timely intervention with the app were multiple.

There was a 50% reduction in imaging tests per patient per year in the app group, compared with the control group. And quality-of-life scores were higher in the app group.

Relapse rates were about 50% in both groups.

The Moovcare app is the first web-application for follow-up and early detection of relapses and complications for patients with advanced lung cancer, according to the Sivan Innovation website. The technology has a patent in the United States and Europe, and is currently undergoing a CE marking procedure in Europe. The company is developing the app for 15 other indications in oncology, including lymphoma. The latter project is being conducted in partnership with Takeda France.

Dr Carbone should be pleased. He believes that technology is not fully tapped in terms of healthcare applications. "The more that these intelligent data captures become readily available, the more everyone benefits," he said.

This study received funding from the Institut de Cancérologie de l'Ouest/Sephira Inc. and Sivan Innovation, the maker of the Moovcare application. Dr Denis reports financial ties with Chugai Pharma and Roche/Genentech, and holding a patent with Sivan Innovation. Dr Smit and Dr Ganz report financial ties with multiple pharma companies, as detailed in the abstract. Dr Masters has disclosed no relevant financial relationships.

American Society of Clinical Oncology (ASCO) 2016 Annual Meeting: Abstract LBA9006. Presented June 6, 2016.

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