Impact of remote therapeutic monitoring on time to discontinuation and acute care events among patients treated with immune checkpoint inhibitors.

Abstract

11108 Background: Immune checkpoint inhibitors (ICI) are used to treat several solid tumors but can cause serious toxicities which may lead to early discontinuation of therapy. This study describes the effect of the Canopy electronic patient-reported outcomes (ePROs)-based remote therapeutic monitoring (RTM) platform on time to treatment discontinuation, acute care events, and steroid prescribing in patients receiving ICI therapy. Methods: We studied patients with metastatic cancer from four oncology clinics who started ICI treatment from Jan 1, 2024 to July 20, 2025. An RTM group was defined by submission of two ePRO reports in the first 45 days after first ICI treatment. The control group was never enrolled or did not submit ePRO reports within 45 days. Time to discontinuation (TTD) of ICI, acute care events, and steroid prescribing were assessed using propensity score weighting to account for potential differences in cohort characteristics; costs were taken as rate differences multiplied by average acute care event cost. TTD was assessed by Kaplan-Meier estimation, Cox proportional hazards modeling, and restricted mean survival time at 90 days (RMST). Descriptive statistics were taken about symptoms in the RTM group versus the control group. Results: The study included 363 patients using RTM and 1,199 in the control group. Lung cancer, melanoma, and kidney cancer were the most frequent diagnoses. In the RTM group time to treatment discontinuation was significantly greater and prescriptions for steroids were more frequent (Table 1). Additionally, RTM use was associated with about a 51% risk of hospitalization (95% CI: 0.29, 0.88, p: 0.015) and 82% risk of ER visits (95% CI: 0.49, 1.39, p: 0.458) compared to the control group. Estimated cost savings in hospitalization associated with RTM use were $11,733,933 per 1000 patients treated for one year. Symptoms were detected more frequently in the RTM group compared to the control group, including potentially ICI-related symptoms such as rash (18% vs 3.2%), diarrhea (28% vs 4.7%), and difficulty breathing (28% vs 4.8%). Conclusions: Active ePRO-based RTM with Canopy is associated with increased time to ICI discontinuation and decreased acute care events. Increased use of steroids in patients reporting symptoms suggesting ICI toxicity may explain the beneficial effect of RTM. Weighted analysis outcomes. Outcome RTM group Control group Risk or Hazard RatioRTM / Control (95% CI) Risk or RMST differenceRTM - Control (95% CI) Time to discontinuation Median: 7.5 mos(95% CI: 6.7, 8.8) Median: 4.1 mos(95% CI: 3.6, 4.6) 0.55(95% CI: 0.47 to 0.64, p < 0.001) 19 days (16, 22) Hospitalization 6.9% 14% 0.51 (0.29, 0.88, p: 0.015) -6.66 (-11.02, -2.13, p: 0.008) Emergency room visit 9.9% 12% 0.82 (0.49, 1.39, p: 0.458) -2.46(-8.05, 2.95, p: 0.366) Steroid use 53% 31% 1.69 (1.41, 2.02, p < 0.001) 21.67(13.90, 29.13, p < 0.001)