Telemedical consultations on oncology in the Republic of Bashkortostan

BACKGROUND: The COVID-19 worldwide pandemic enabled the expanded use of telemedical technologies in many areas of medicine. Remote consultations helped conserve medical resources and reduce the risk of spreading COVID-19 while preserving patients access to medical care. In addition, telemedicine played a role in caring for patients who live in remote regions. Other benefits include savings in transportation costs and travel time both for patients and caregivers. Telemedicine, together with remote health monitoring technologies, has high potential in developing a preventive healthcare system and increasing the accessibility of medical care and meets current challenges by improving healthcare quality and providing an individual approach to patients. In 2020, the Center of Telemedicine was created in the Republican Clinical Oncological Dispensary (RCOD) to organize and improve telemedical assistance to the population of the Republic of Bashkortostan in the oncology profile. AIM: To analyze telemedical consultations (TMCs) on oncology in the Republic of Bashkortostan for the period of 20202022. METHODS: Quantitative count and comparison of the TMCs conducted by the RCOD of the Ministry of Health of the Republic of Bashkortostan in 20202022 and sent to the National Medical Research Center (NMRC) were performed. The work on referrals to the NMRC for revision of examination results (computer tomography, magnetic resonance imaging, positron emission tomography/computed tomography, and histological examinations), obtaining a second opinion, and determining treatment tactics was organized. RESULTS: In 2020, 32,076 TMCs were conducted, while 225 TMCs were performed with the NMRC. In 2021, the RCOD conducted 52,139 TMCs (a 62% increase compared to 2020), whereas 473 TMCs took place in the NMRC (a 110% increase compared to 2020). During the 12 months of 2022, 57,456 TMCs were performed by RCOD staff (a 10% increase over the previous year), and 672 TMCs were conducted with the NMRC (a 42% increase compared to 2021). For feedback from referring medical organizations and monitoring and evaluating the quality of regional TMCs, conference calls were held with the Ministry of Health of the Republic of Bashkortostan, chief physicians, and oncologists of the Republic of Bashkortostan. CONCLUSIONS: TMCs allow for the rapid exchange of medical information, thereby reducing the time of diagnosis and timely prescription of treatment, the implementation of timely routing of patients and improving the quality and availability of medical care in the oncology profile in the Republic of Bashkortostan. The annual increase in the number of TMCs is due to the growing need for this type of specialized medical care in this profile

Efficacy and safety of erdafitinib in patients with locally advanced or metastatic urothelial carcinoma: long-term follow-up of a phase 2 study

Background Erdafitinib, a pan-fibroblast growth factor receptor (FGFR) tyrosine kinase inhibitor, was shown to be clinically active and tolerable in patients with advanced urothelial carcinoma and prespecified FGFR alterations in the primary analysis of the BLC2001 study at median 11 months of follow-up. We aimed to assess the long-term efficacy and safety of the selected regimen of erdafitinib determined in the initial part of the study. Methods The open-label, non-comparator, phase 2, BLC2001 study was done at 126 medical centres in 14 countries across Asia, Europe, and North America. Eligible patients were aged 18 years or older with locally advanced and unresectable or metastatic urothelial carcinoma, at least one prespecified FGFR alteration, an Eastern Cooperative Oncology Group performance status of 0–2, and progressive disease after receiving at least one systemic chemotherapy or within 12 months of neoadjuvant or adjuvant chemotherapy or were ineligible for cisplatin. The selected regimen determined in the initial part of the study was continuous once daily 8 mg/day oral erdafitinib in 28-day cycles, with provision for pharmacodynamically guided uptitration to 9 mg/day (8 mg/day UpT). The primary endpoint was investigator-assessed confirmed objective response rate according to Response Evaluation Criteria In Solid Tumors version 1.1. Efficacy and safety were analysed in all treated patients who received at least one dose of erdafitinib. This is the final analysis of this study. This study is registered with ClinicalTrials.gov, NCT02365597. Findings Between May 25, 2015, and Aug 9, 2018, 2328 patients were screened, of whom 212 were enrolled and 101 were treated with the selected erdafitinib 8 mg/day UpT regimen. The data cutoff date for this analysis was Aug 9, 2019. Median efficacy follow-up was 24·0 months (IQR 22·7–26·6). The investigator-assessed objective response rate for patients treated with the selected erdafitinib regimen was 40 (40%; 95% CI 30–49) of 101 patients. The safety profile remained similar to that in the primary analysis, with no new safety signals reported with longer follow-up. Grade 3–4 treatment-emergent adverse events of any causality occurred in 72 (71%) of 101 patients. The most common grade 3–4 treatment-emergent adverse events of any cause were stomatitis (in 14 [14%] of 101 patients) and hyponatraemia (in 11 [11%]). There were no treatment-related deaths. Interpretation With longer follow-up, treatment with the selected regimen of erdafitinib showed consistent activity and a manageable safety profile in patients with locally advanced or metastatic urothelial carcinoma and prespecified FGFR alterations