Patient and oncologist preferences for ALK+ advanced non-small cell lung cancer tyrosine kinase inhibitor treatments: a discrete choice experiment in the United States

Abstract

Purpose: Next-generation anaplastic lymphoma kinase (ALK)-targeting tyrosine kinase inhibitors (TKIs) are standard first-line (1L) treatments for ALK+ advanced non-small cell lung cancer (aNSCLC). Treatments differ in systemic and central nervous system (CNS) efficacy and adverse event (AE) profiles. There is a need for understanding treatment preferences of patients and oncologists in this setting.

Patients and methods: Patients receiving TKIs for ALK+ aNSCLC and oncologists were recruited from patient databases, patient advocacy groups and an online panel to complete a discrete choice experiment, which included progression-free survival (PFS), brain metastases (BM) development, BM progression, metabolic events, weight gain, CNS AEs, fatigue/asthenia, and muscle/bone pain. Responses were analyzed using a mixed logit model. Relative attribute importance (RAI), minimum acceptable benefit, and maximal acceptable risk were calculated.

Results: Of the 151 patients, 23.2 % had BM and 50.3 % were on 1L treatment. Treatment benefits outweighed AEs and contributed to 73.6 % of patients' and 67.0 % of oncologists' total RAI. Stopping BM progression was most important to patients (27.2 %), whereas PFS was most important to oncologists (31.1 %). Oncologists placed two and four times as much importance on avoiding CNS AEs and metabolic events, respectively, than patients. Patients placed more importance on avoiding fatigue/asthenia than oncologists.

Conclusions: To our knowledge, this was the first study to quantify preferences regarding 1L treatments for ALK+ aNSCLC in the US. As patients and oncologists were shown to have different priorities, understanding the differing trade-offs between treatment benefits and AEs can facilitate shared decision-making and personalized 1L treatment for ALK+ aNSCLC.

Keywords: Adverse effects; Anaplastic lymphoma kinase; Carcinoma; Non-small-cell lung cancer; Patient preference; Treatment outcome; Tyrosine kinase inhibitors.