Transcript

I'm Dr Julie Gralow. I'm the Director of Breast Medical Oncology at the Seattle Cancer Care Alliance, and the Jill Bennett Endowed Professor of Breast Medical Oncology at the University of Washington. I'll be discussing some abstracts that will be presented at the ASCO 2020 virtual scientific meeting.

The SWOG S1105 study was an interesting trial, looking at whether text messaging could help people with compliance or adherence to their adjuvant aromatase inhibitors. We know that this is a big problem.

Even in clinical trials where patients might be a bit more motivated to continue on for 5 years, or now with recommendations going out to 10 years in some cases for adjuvant aromatase inhibitors, even in those settings, we see a fairly high drop off rate, where patients can't meet the full 5 or 10 years of treatment. It's for a variety of reasons.

Sometimes it's toxicities that can occasionally be due to cost, or just not wanting to take a drug that long when a patient is hoping and believing that they might be cured. The original study, S1105, randomized patients who were just starting adjuvant aromatase inhibitors but had been on them for a little while, to receive twice a week, a text message with helpful hints or encouragement to stay on the drug versus not.

That study has actually been presented and published and showed that one-way text messaging that wasn't really personalized to the patient was not helpful in adherence. Only about 60 percent of patients were able to stay on the drug for the three year period of the study.

We scratched our heads and said, "Well, what might benefit?" We went back, and an important part of the study was that we looked at features of the patient. We did patient-reported outcomes at baseline when they entered the study. We looked at things like a brief pain inventory. Were they already having pain?

The joint aches are a big reason a lot of patients stop their adjuvant aromatase inhibitors. We did a FACT-ES. The ES stands for endocrine symptoms. Were the patients already having hot flashes, night sweats, and other endocrine symptoms, as they entered the study?

We did a couple of validated brief looks at medication thoughts. What do patients believe about medications, their benefits, and toxicities at baseline? What we found was that we could pick out a group who were more likely to be non-adherent to their adjuvant aromatase inhibitor. Adherence was measured actually by urine assays.

We could look in the urine at whether patients were taking their drugs. We didn't just rely on patient reporting. We looked to see, were they getting the drug in their system? Younger women tended to have more likelihood of dropping off their adjuvant endocrine therapy.

Women who at baseline already had pain or endocrine symptoms, or who met certain criteria in the PROs related to their beliefs about medications, these patients were more likely to drop off of the drug and not be able to complete their full course. What we found was, we could pick out or select a group who were more likely to not be able to stay on the drug for the full time than it's been prescribed.

We could pick out a group who were highly likely to stay on the drug. That group, the group that was able to be adherent and compliant, we probably don't need to continue to study. The group that was not able to be adherent, we need to look for how to help them.

We're investigating other ideas. Instead of just a passive one-directional text messaging that's not personalized, could we make it two-directional, where the patient could report in symptoms and ask questions so that the messages would get personalized? Depending on the symptoms they were having, we could direct to different studies, different ideas about how to manage them.

That's something that we're looking at. Would a personalized and 2-directional text messaging help that higher risk group be able to stay on the drug? Give them the information that they need, to be able to give themselves the best outcome in terms of reducing recurrences. An interesting study.

Where the primary study was negative, the text messaging didn't help patients stay on the drug. We're able to identify a higher risk group that we will continue to study, and try to help them be able to tolerate aromatase inhibitors for the duration.