MultiDom telemonitoring (circadian rhythm + ePRO) cuts emergency admissions to 3.8% during upfront mFOLFIRINOX in advanced PDAC

MultiDom (NCT04263948) is a prospective, multicentre, single-arm digital intervention layering continuous chest-sensor circadian monitoring (dichotomy index I<O), daily connected weight, and MDASI-based ePROs to trigger clinician alerts during the first 3 cycles of mFOLFIRINOX for advanced pancreatic ductal adenocarcinoma (n=52; 69% metastatic; PS 0–1 in 92%). Emergency admissions occurred in 2 patients (3.8% [95% CI 1.1–13]) with grade 3 febrile neutropenia/diarrhea and grade 3 leuco-neutropenia/hypokalemia, meeting the study hypothesis versus historical EA rates of ~15–30% in this setting; grade 3–4 neutropenia was 17% (95% CI 9–30) (vs typical febrile neutropenia ~5–10% reported across FOLFIRINOX/mFOLFIRINOX series). Symptom-free circadian disruption (I<O ≤96%) preceded both emergency admissions by 8 days, while circadian disruption occurred at least once in 65–75% and persisted >20 days in 52%; at 2 months, disease control rate was 75% (wide CI: 53–100), with high platform adherence (generally 84–100% across streams) and heavy alerting (1,881 e-alerts; 43% circadian-driven).