Patient preference for first-line treatments of ALK-positive metastatic non-small cell lung cancer: A discrete choice experiment.

Abstract

11103 Background: For patients with ALK-positive metastatic NSCLC, targeted therapy with ALK inhibitors is a recommended first-line treatment. The development and approval of ALK-TKIs have resulted in longer survival benefits for patients with ALK-positive mNSCLC. Three generations of ALK-TKIs are now available, varying in efficacy and side effects. Therefore, it is important to identify patients' priorities and the benefit-risk trade-offs patients are willing to make among potential treatment options. This study quantified the preferences of patients for attributes of ALK-positive mNSCLC first-line treatment. Methods: An online discrete choice experiment was conducted to elicit the preferences of Patients with ALK-positive mNSCLC and their family members (both decision-makers for the treatment). Respondents completed multiple hypothetical treatment profiles characterized by 7 attributes, including progression-free survival (PFS), reduced risk of brain metastasis, intracranial complete response (iCR), degree of cognitive side effects, risk of liver damage, risk of severe hyperlipidemia and the dose reduction rate. Data were analyzed using a conditional logit model and mixed logit model. Results: Respondents (N=115) placed most value on PFS (RI=58.13%), followed by reduced risk of brain metastasis (RI=13.04%). Attributes related to side effects were considered less critical in respondents' decision-making. Respondents exhibited a willingness to accept an increased risk of treatment for improved clinical outcomes. When the degree of side effects was altered from mild to moderate, respondents require a minimum increase of 5.34 months in PFS as compensation to maintain the same utility. Scenario analysis estimated 97.06% of respondents would endorse the new treatment option if the PFS was improved from 36 months to 60 months. Subgroup analysis revealed that the preference patterns of patients and their families are similar. However, respondents' preferences exhibit heterogeneity for patients with different brain metastasis status, age, and annually household income. Conclusions: This is currently the first patient preference study for First-Line Treatments of ALK-positive mNSCLC. The results revealed that patients' decision makers place the highest priority on PFS, with comparatively less emphasis on side effects, and they are willing to accept a higher risk of side effects in exchange for prolonged survival. Understanding these preferences can enhance shared decision-making between patients and clinicians, fostering personalized prophylactic treatment plans that may optimize adherence and improve clinical outcomes.