Patient and caregiver treatment preferences for ALK+ non-small cell lung cancer in the United States.

Abstract

8617 Background: Treatment options for non-small cell lung cancer (NSCLC) with ALK rearrangement (ALK+) have distinct benefits and risks. As patients often use ALK inhibitors for years, balancing these considerations is crucial. This study quantified how benefits and risks drive treatment preference and trade-offs between them from patients’ and caregivers’ perspectives. Methods: A discrete choice experiment (DCE) was completed online by Stage 4 ALK+ NSCLC patients and caregivers, recruited via physicians and the ALK Positive advocacy group. The DCE (developed based on literature review, phase 3 trial data and qualitative interviews) repeatedly asked participants to choose between 2 hypothetical treatments described by 7 benefit/risk attributes, each with a plausible clinical level. A mixed logit model estimated the relative impact of each attribute on preferences as relative attribute importance (RAI) and maximum acceptable loss (MAL) of 3-year progression-free survival (PFS) for reduced treatment risks. Results: 205 patients (mean age 61.9 years old; mean time since diagnosis: 2.7 years; 34.1% with brain metastasis) and 125 caregivers participated. 29.8% patients and 33.6% caregivers chose treatments based solely on PFS. Treatment preferences were mainly driven by 3-year PFS with less importance placed on adverse events (RAI: patients 4.0-11.0%; caregivers 3.7-13.3%) (Table). Patients were willing to forgo 3.9-8.7% of 3-year PFS to reduce risks of any grade cognitive/mood effects, grade ≥3 abnormal lab results, grade ≥3 lung complications, grade ≥3 weight gain, and any grade myalgia; caregivers were willing to trade 3.7-7.2% of 3-year PFS to reduce any grade cognitive/mood effects, grade ≥3 abnormal lab results, and grade ≥3 lung complications, but not any grade myalgia or grade ≥3 weight gain. Conclusions: Patients and caregivers highly prioritized achieving a higher chance of 3-year PFS when choosing treatments. Most were willing to trade PFS benefit for reduced risks, although there was a subset of caregivers who were unwilling to trade any benefit for reduced risks. The extent varied between patients and caregivers. Shared treatment decision making between physicians and patients/caregivers should consider the balance between benefits and risks. RAI and MAL. RAI MAL of 3-year PFS Attributes (Levels) Patients (n=205) Caregivers (n=125) Patients (n=205) Caregivers (n=125) 3-year PFS(30-65%) 50.8% 51.6% NA NA Any grade cognitive/mood effects(0-25%) 11.0% 13.2% 8.7% 7.2% Grade ≥3 lung complications(0-6%) 9.3% 6.7% 5.4% 3.7% Grade ≥3 abnormal lab results(0-30%) 8.7% 13.3% 6.8% 5.5% Grade ≥3 weight gain(0-20%) 8.5% 4.5% 4.7% NS Any grade myalgia(0-20%) 7.6% 7.2% 3.9% NS Tumor progression in the brain within 3 years(10-55%) 4.0% 3.7% 6.1% NS NS: not statistically different to zero (p≥0.05), indicating unwillingness to forgo 3-year PFS to reduce these risks.