Breast cancer is one of the most common types of cancer in women with over 2 million new cases worldwide in 2020 (https://www.iarc.who.int/cancer-type/breast-cancer).

Advanced or metastatic breast cancer (MBC) means that the cancer has spread to other parts of the body and other organs such as bone, liver or lung. MBC is still considered an incurable disease.[i] Living with MBC is a challenge. Treatment goals are prolongation of survival and improvement or maintenance of quality of life (QoL) under therapy by sufficient control of cancer-related symptoms.[ii]

In hormone receptor (HR)-positive, HER2-negative (HR+/HER2-) MBC, CDK4/6 inhibitor-based therapy is now standard of care¹, as patient outcome has improved substantially with good QoL across all lines of therapy. CDK4/6 is a protein complex comprises of cyclin-dependent kinases 4 and 6 that serve as a checkpoint in cell division and growth, and its deregulation can induce abnormal cell proliferation and cancer development. Palbociclib is an oral drug and works by targeting the CDK4/6 protein complex in breast cancer cells, causing the cancer to slow or stop growing.

Palbociclib was the first approved CDK4/6 inhibitor worldwide and thus provided a good opportunity to test the benefits of eHealth-based therapy management under oral cancer therapy. First clinical data regarding benefits of eHealth support were generated by remote patient monitoring (RPM) systems supervised by oncologists or trained nurses with regular patient-reported outcome (PRO) documentation.[iii]^,[iv]

CANKADO (https://cankado.com) is a next-generation, interactive, autonomous eHealth application, and an EU-registered medical device (DE/CA59/BS 392/2021). It works without any intervention by a healthcare professional and can self-detect points in time to initiate symptom questionnaires. The application is available in many languages. The aim of CANKADO is to empower patients, prepare them better for the next contact with the treatment team and initiate this contact when needed due to self-reported symptoms. Patients are queried daily about their general health merely by a smiley slider, graphically based on the EQ visual analogue scale (EQ-VAS).[v] Based on the documented changes in the EQ-VAS value, the software selects the appropriate time to trigger a 14-symptom questionnaire. Once symptoms and their grade of severity are documented, the system recommends to the patient whether and how urgently the treatment center should be contacted. In contrast to an RPM system, healthcare professionals are not involved at any time point until the patient contacts the center.

In the PreCycle randomized, phase IV clinical trial, researchers investigated the impact of a next-generation, interactive, autonomous eHealth application on patient QoL as well as treatment efficacy of palbociclib-based therapy in the approved indications.