Patient and physician preferences for treatment in advanced renal cell carcinoma (PEAR): An international, multi-centre discrete choice experiment (DCE).

Abstract

443 Background: There are several treatment options for advanced renal cell carcinoma (aRCC) but limited evidence for treatment preferences in Asia-Pacific populations. This study evaluates patient and physician preferences for first-line aRCC treatment. Methods: A discrete choice experiment was conducted among 81 patients with aRCC, both clear cell and non–clear cell subtypes, and among 75 physicians with ≥5 years of experience managing aRCC in Australia, Hong Kong, and South Korea. Seven key efficacy and safety attributes were short-listed based on literature reviews, qualitative interviews and expert consultation: progression-free survival (PFS), overall survival (OS) rate at 3 years, complete response (CR) rate, duration of response (DoR), hospitalization for side effects, grade 3 or 4 lung inflammation, and grade 3 or 4 gastrointestinal (GI) perforation. Preference weights for attribute levels were estimated using a mixed logit regression model, and the relative importance score (out of 100%) for each attribute was calculated. Maximum acceptable risk (MAR), the additional adverse event (AE) risk patients and physicians would accept for incremental efficacy, was derived by dividing the benefit preference difference by the risk preference difference. Results: The median age of patients was 63 (interquartile range 55-68) years. All patients were receiving systemic therapy for aRCC at the time of survey; 73% reported treatment-related AEs. Among physicians, 55% had at least 16 years of experience managing aRCC. Patients placed the greatest importance on grade 3 or 4 lung inflammation (23%), followed by DoR (19%), OS rate at 3 years (18%), and CR rate (17%). PFS ranked the lowest importance (2%) among patients. In contrast, physicians placed the highest importance on OS rate at 3 years (29%), DoR (26%) and CR rate (15%), while PFS (14%) and AEs were relatively less influential. Grade 3 or 4 lung inflammation was given the lowest importance (2%) among physicians. MAR analysis indicated physicians were more willing to accept substantially higher lung inflammation risk for efficacy gains than patients but were more cautious about GI perforation. Conclusions: Both patients and physicians valued longer OS, higher CR, and longer DoR, but their benefit-risk trade-offs differed. Physicians prioritized efficacy parameters, and tolerated higher risk for lung inflammation, possibly due to their clinical experience in managing this AE, whereas patients were more risk-sensitive. Relative importance of attributes (%). Attribute Patients- Relative importance (%) Physicians- Relative importance (%) Inflammation of lung grade 3/4 23 2 DoR 19 26 OS rate at 3 years 18 29 CR rate 17 15 GI perforation grade 3/4 13 7 Chance of admission due to treatment S/E 8 7 PFS 2 14