Adherence, exposure and patients’ experiences with the use of erlotinib in non-small cell lung cancer

Abstract

PurposeErlotinib is an orally administered tyrosine kinase inhibitor used for treatment of non-small cell lung cancer. Understanding actual use of medication is essential for optimizing treatment conditions.MethodsIn this multicentre prospective observational study, patients starting erlotinib treatment were followed for 4 months. Adherence was assessed using a medication event monitoring system (MEMS). Area under the curve (AUC) was determined after 1, 2 and 4 months. Before start and at monthly intervals, patients filled out questionnaires about attitude towards medication and disease, quality of life, symptoms and use in daily practice.ResultsSixty-two patients (median age 63.5 years, 53 % male) were included of whom 15 were still on treatment after 4 months. MEMS data of 55 patients revealed a mean adherence of 96.8 ± 4.0 %. Over one-third of patients had an adherence rate <95 %. At 1 month, 21 % of patients did not always correctly take erlotinib without food. Associated risk factors were older age, suboptimal adherence, ocular symptoms and stomatitis (all p < 0.05). After 1 month of treatment, fatigue (91 %) and rash (86 %) were the most common symptoms reported. AUCss of erlotinib was higher in patients with rash and patients with moderate–severe anorexia (both p < 0.05).ConclusionThough adherence to erlotinib treatment is generally high, non-adherence might be an issue in a considerable number of patients. To support optimal erlotinib intake, clinicians need to take adequate measures to ameliorate symptoms and to address adherence and correct intake without food. Especially older patients and those who experience stomatitis may need extra attention.

Oral antineoplastic agents: how do we care about adherence?

“…In studies using MEMS for adherence assessment (Table ), the mean adherence rates ranged between 74 and 100% . Studies assessing the proportion of patients with adherence rates greater than or equal to a threshold of 80% found rates of 75% to 86%.…”

Adherence to oral anticancer agents: Healthcare providers’ perceptions, beliefs and shared decision making in Belgium and the Netherlands

“…Studies on HCP-related factors influencing non-adherence in patients treated with short-term OACA (e.g. erlotinib, sunitinib) are scarce [10,11].…”

The Association Between Patient-Reported and Objective Oral Anticancer Medication Adherence Measures: A Systematic Review

“…MPR and patient self-rated adherence were significantly correlated (r = 0.68, p < 0.001) in a study of patients with chronic myeloid leukemia (Daouphars et al, 2013). Two separate studies of patients with hematologic malignancies and lung cancer conducted by Timmers et al (2014, 2015) demonstrated a significant association between patient-reported OAM adherence, as captured by MARS, and objective assessments. Walter et al (2013) found, in a study of patients with gastrointestinal malignancies, that patient-reported OAM adherence had a significant positive association with objective pill counts, but not MEMSCap.…”

“…Two studies captured patient-reported OAM adherence using the Medication Adherence Rating Scale (MARS) (Timmers et al, 2014, 2015), whereas one employed the Basel Assessment of Adherence Scale (BAAS) (Gebbia et al, 2013). …”

“…The VAS ranged from 0 (no adherence) to 100 (perfect adherence) (Gebbia et al, 2013). MEMSCap recorded adherence through documenting each medication bottle opening as a dose (Timmers et al, 2015; Walter et al, 2013; Waterhouse, Calzone, Mele, & Brenner, 1993). …”