The role of rehabilitation of patients with renal cell carcinoma receiving cabozantinib combined with nivolumab

Abstract

Cabozantinib is an inhibitor of various receptor tyrosine kinases involved in tumor growth and angiogenesis. According to these recommendations, the combination of cabozantinib and nivolumab is the preferred regimen in the first line of treatment of clear cell RCC of all IMDC prognosis groups based on repeatedly proven effectiveness. Meanwhile, the combination demonstrates a safety profile associated with a deterioration in quality of life in most cases. The purpose of the research was to study the impact of nutritional support and other rehabilitation measures on the quality of life of patients, the acceptability of antitumor therapy, and overall satisfaction with treatment in patients receiving cabozantinib in combination with nivolumab. Materials and methods. The study included 48 patients diagnosed with renal cell cancer who received combination therapy with cabozantinib and nivolumab, divided into two groups: the study group (n = 25) and the control group (n = 23). In the study group, the patients received a set of additional rehabilitation measures (magnetic therapy, physical therapy, nutritional support, psychological support); in the control group, the patients received only antitumor therapy without the rehabilitation program. To assess the quality of life, the Russian version of the EORTC QLQ-C30 questionnaire was used. The severity of adverse events was assessed according to CTCAE 5.0 criteria. Results. The introduction of the patient rehabilitation program into the complex of antitumor treatment showed a significant reduction in the severity of side effects and the frequency of their development. During treatment, an improvement in the nutritional status of the patients was noted: a decrease in general weakness (70 % in the study group versus 45 % in the control group), improved appetite (62 % in the control group versus 43 % in the study group), a lower incidence of weight loss (51 % in the control group versus 39 % in the study group), which indicates the significant role of nutritional support. Dynamic monitoring of laboratory parameters revealed a lower incidence of anemia among the patients in the study group. Conclusion. The use of nutritional support, physical therapy, magnetic therapy, and psychological support helps to reduce the frequency and severity of adverse events, improve tolerability of antitumor therapy, decrease the risk of serious adverse events, and improve quality of life, which in turn increases patient adherence to treatment, leading to more thorough implementation of recommendations. As a result, the effectiveness of treatment increases.