Patient (pt) preferences for treatment (tx) of non-metastatic hormone-sensitive prostate cancer (nmHSPC): A discrete choice experiment (DCE).

Abstract

338 Background: Prostate cancer tx guidelines recommend androgen receptor pathway inhibitors (ARPI) ± androgen-deprivation therapy (ADT) as an effective alternative to ADT alone for pts with high-risk biochemically recurrent nmHSPC. ARPI ± ADT offers improved efficacy and a tolerable safety profile compared with ADT alone; however, understanding which attributes pts consider most when assessing tx options is important. This study quantified pt preferences for ARPIs ± ADT vs ADT alone in pts with nmHSPC across 9 countries, using a DCE method. Methods: Using convenience sampling, an online panel-based DCE survey was developed and administered to 374 pts with nmHSPC who had undergone definitive tx. The DCE included 14 choice cards, each presenting 2 hypothetical tx options with varying levels of efficacy (metastasis-free survival [MFS], tx suspension), tx-emergent adverse events (risk of fatigue, hot flashes, breast swelling), and sexual well-being (duration of interest in sex, duration of keeping erectile function). MFS was selected, as it served as a key efficacy endpoint in an nmHSPC study and is associated with overall survival. Pts were recruited from US (n = 56), Italy (n = 53), Germany (n = 52), UK (n = 43), Brazil (n = 40), France (n = 40), South Korea (n = 40), Spain (n = 40), and Australia (n = 10). Preference weights were estimated using a random parameter logit model. Relative attribute importance was derived from these weights and the corresponding attribute levels. EMBARK trial profiles for ARPI and ADT informed tx choice probabilities, and pts were assigned to the option with the highest predicted probability. Results: Median age was 66 years (IQR: 63.0–69.0). Of all pts, 245 (66%) were married/in a relationship and 109 (29%) were sexually active. Recurrence occurred in 157 (42%) pts after definitive tx. The most important attributes were 5-year MFS, risk of hot flashes, and duration of sexual interest relative to pre-tx baseline (Table). Among the pts, 363 (97%) selected ARPI ± ADT as their preferred tx option while 11 (3%) preferred ADT alone. Conclusions: In this DCE study, pts preferred ARPIs ± ADT vs ADT alone. MFS was the most significant driver of pt choices, followed by risk of hot flashes then interest in sex. These preferences suggest that ARPI-based txs may be viewed more favorably, which may reflect pts’ risk-benefit tradeoffs, favoring txs that balance clinical effectiveness, adverse events, and impact on sexual quality of life. Overall, the results support using personalized care plans for pts with nmHSPC. Attribute Relative importance, % (95% CI) 5-year MFS 28.9 (22.7, 35.2) Risk of hot flashes 18.6 (12.8, 24.5) Duration of sexual interest while on tx 17.4 (11.9, 22.9) Risk of breast swelling 11.7 (6.7, 16.8) Tx suspension 8.2 (1.5, 14.8) Duration of keeping erectile function while on tx 7.6 (2.6, 12.7) Risk of fatigue 7.5 (2.3, 12.6)