Patient and Physician Preferences for Maintenance Treatment in Advanced Non-Small Cell Lung Cancer: Insights into Treatment Selection.

Abstract

Introduction: Advanced/metastatic non-small cell lung cancer (a/mNSCLC) is associated with a poor prognosis. Although maintenance therapy after first-line (1L) induction treatment can extend survival, it may also present with drawbacks like risk of certain adverse events (AEs), underscoring the need for shared decision-making between patients and their treating physicians. This study aimed to quantify the extent to which maintenance treatment attributes impact the preferences of patients and physicians after 1L induction therapy for a/mNSCLC.

Methods: Eligible patients (aged ≥ 18 years in the UK and US) were diagnosed with a/mNSCLC and had stable disease with or responded to 1L induction therapy. Eligible physicians were licensed oncologists with ≥ 5 years' experience in a/mNSCLC treatment who had treated ≥ 20 such patients in the past year. Surveys assessed the patients' and physicians' perspectives regarding the current treatment landscape of a/mNSCLC, and a discrete choice experiment assessed their preferences regarding treatment characteristics. Data were collected using choice cards, designed to capture treatment attribute preferences including efficacy (progression-free survival [PFS] and overall survival [OS]), chance (risk) of new brain metastasis (BM), and selected AEs.

Results: Among 34 UK and 48 US patients, the three most important treatment attributes (in order) were chance of new BM, OS, and risk of severe neutropenia. Among 51 UK and 50 US treating physicians, the 3 most important treatment attributes (in order) were OS, chance of new BM, and PFS.

Conclusion: In this real-world survey, OS and chance of new BM were the two most important maintenance treatment attributes for patients with a/mNSCLC and treating physicians. However, the risk of severe neutropenia carried greater relative importance, while PFS carried lesser relative importance, for patients than physicians. These results highlight the differing emphasis placed on attributes by patients and physicians when selecting maintenance treatment.