Figure 2. Blood pressure, weight, and steps/day changes for patient 1 (A) and patient 2 (B) for 90 consecutive days.
X axis shows days on treatment. Home (remote monitoring) versus clinic readings are shown. For patient 1, axitinib was
initiated on day 6. For patient 2, pazopanib was initiated on day 1. SBP = Systolic blood pressure. DBP = Diastolic
blood pressure.
Kidney Cancer Journal 103
showing EF of 59%. The patient had a very nice response
to pazopanib with a resolved pleural effusion and decreased
size of her right lower lobe pleural effusion, but
was switched to everolimus due to cardiotoxicity from pazopanib.
The patient progressed on everolimus, and for
third line systemic therapy, she was started on axitinib
(another VEGF receptor-TKI) at a low dose of 3 mg twice
daily. Of clinical concern was that the patient could be at
high risk for repeat cardiotoxicity when starting axitinib
therapy and needed close monitoring of her cardiovascular
status including blood pressure.
Prior to starting on axitinib the patient was enrolled in
our clinical study, and we initiated daily home blood pressure,
weight, and activity monitoring with mHealth technology.
To minimize her risk of cardiotoxicity, we aimed
to keep her blood pressure less than 140/90. Figure 2A
shows her blood pressure at four interval clinic visits during
the first 90 days compared to the data from home
blood pressure monitoring. In this particular case, home
blood pressure monitoring detected blood pressure rises
above SBP > 140 more quickly than monitoring only during
clinic visits. Anti-hypertensive medications were uptitrated
at the first interval clinic visit, which was approximately
2 weeks after the initiation of axitinib therapy.
Significant weight loss was detected sooner with mHealth
monitoring compared to interval clinic visits. Also of interest,
her performance status was measured at KPS 90
and ECOG of 1 during each clinic visit during the 90-day