Proactive Onco-Coaching Improves Survival in Metastatic Kidney Cancer

Viktor Grünwald, MD

Findings from the 2025 ASCO Genitourinary Cancers Symposium revealed that proactive onco-coaching, while not significantly enhancing quality of life (QOL), was associated with improved overall survival (OS) in patients with metastatic renal cell carcinoma (mRCC) receiving tyrosine kinase inhibitors (TKIs) and immune checkpoint inhibitors (ICIs).¹ These results highlight a potential benefit of structured coaching interventions in cancer management.

Eligible patients (n = 113) were randomized 1:1 to proactive onco-coaching or standard-of-care (SOC) treatment. The coaching track entailed 8 visits with a trained nurse that included structured interviews educating patients on preventive, preemptive, and supportive measures as well as phone call follow-ups continuing until 24 weeks. Data were collected from 2016 to 2023.

Median OS was higher in the group that received coaching at 49.6 months (95% CI, 30.6-61.6) vs 25.4 months in the SOC group (95% CI, 17.8-not reached; P = .11). Both arms had similar progression-free survival, with a median of 11.1 months for those with coaching (95% CI, 8.3-18.9) and 9.2 months for SOC (95% CI, 5.6-14.6; P = .21).

Though stratification by Charlson comorbidity index (CCI) did not affect OS (P = .26), patients with CCI scores 2 or higher had the lowest OS in the SOC group (15.7 months vs 33.4 months; P = .002).

“An interesting subgroup analysis indicated that patients that really had a higher Charlson comorbidity index seemed to be benefitting more from the structured oncological coaching, indicating that maybe the effect of the onco-coaching may be applicable to [a] certain subgroup of patients,” said Viktor Grünwald, MD, a medical oncologist in Interdisciplinary Genitourinary Oncology, the West-German Cancer Center, Clinic for Medical Oncology, Clinic for Urology, Essen University Hospital, said in the presentation of data.

The study’s primary end point was determining the fraction of patients who experienced an increase in QOL of 3 points or greater on the FKSI-15 index using coaching. QOL improvement by 3 points or higher was observed at similar levels between the coaching and SOC arms (39.1% vs 39.5%).

Adverse effects (AEs) of any grade were recorded at similar levels among those who did and did not receive coaching (n = 55, 100% vs n = 53, 96.4%). The coaching arm experienced a higher rate of any AEs grade 3 or higher at 81.8% (n = 45) compared with 56.4% (n = 31) in the SOC arm.

Treatment-related AEs (TRAEs) occurred at higher rates in the coaching arm. TRAEs of any grade occurred in 96.4% (n = 53) of patients enrolled on the coaching arm and in 85.5% (n = 47) of those on the SOC arm; grade 3 or higher TRAEs were observed in 52.7% (n = 29) and 36.4% (n = 20) of patients, respectively.

The coaching track had a face-to-face baseline assessment of the patient’s therapeutic comprehension and expectation, social/accommodation, health awareness, and information on relevant AEs. Subsequent contact with patients was either face-to-face or over the phone. Following baseline assessment, nurses assessed patients’ hypertension, fatigue, diarrhea, stomatitis, and hand-foot syndrome during treatment.

Pre-defined intervention levels, assigned after assessments, was categorized as level 1 (preemptive), level 2 (non-pharmacological), or level 3 (therapeutic). Coaching intervention had an 80% rate of completion, a 16% rate of partial completion, and a 4% rate of non-compliance. The median number of coaching visits was 13, with a maximum of 19 visits.

The planned sample size of 430 patients was not met, which researchers attribute to changes in treatment landscape and the COVID-19 pandemic, which took place during the study.

“The study duration between 2017 and 2024 has been quite long, and there has been a lot of changes in regard to the standard of care, but also because of the pandemia that occurred globally,” explained Grünwald. “The changes in treatment landscape and pandemia that occurred at that time compromised study recruitment and execution.”

All participants had treatment-naïve mRCC and received treatment with axitinib plus avelumab, axitinib plus pembrolizumab, or sunitinib, and 44% had a CCI score of 2 or higher. The median ages of coaching and SOC groups were 72 and 68 years, respectively. The same number of patients in both groups discontinued use of TKIs (n = 4, 7.3%), and more patients in the coaching group discontinued use of ICIs (n = 7, 12.7% vs n = 2, 3.6%).

Reference

Grünwald V, Jacobbasch L, de Wit M, et al. A phase III study testing the role of proactive coaching on patient reported outcome in advanced or metastatic renal cell carcinoma treated with sunitinib or a combination of axitinib + pembrolizumab or avelumab in first line therapy (PREPARE; AIO-NZK-0115/ass). J Clin Oncol. 2025;43(suppl 5):523. doi: 10.1200/JCO.2025.43.5_suppl.523