Patient Preferences for First-Line Treatment of Locally Advanced or Metastatic Urothelial Carcinoma: An Application of Multidimensional Thresholding.

Autor: Apolo AB; Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA., Michaels-Igbokwe C; Evidera, Montreal, QC, Canada. christine.michaels-igbokwe@evidera.com., Simon NI; Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA., Benjamin DJ; Hoag Family Cancer Institute, Newport Beach, CA, USA., Farrar M; Pfizer Inc, Bothell, WA, USA., Hepp Z; Pfizer Inc, Bothell, WA, USA., Mucha L; Astellas Pharma, Inc, Northbrook, IL, USA., Heidenreich S; Evidera, London, UK., Cutts K; Evidera, Montreal, QC, Canada., Krucien N; Evidera, London, UK., Ramachandran N; Evidera, London, UK., Gore JL; Department of Urology, University of Washington, Seattle, WA, USA.
Jazyk: angličtina
Zdroj: The patient [Patient] 2024 Aug 28. Date of Electronic Publication: 2024 Aug 28.
DOI: 10.1007/s40271-024-00709-3
Abstrakt: Objectives: Patient preferences have the potential to influence the development of new treatments for locally advanced/metastatic urothelial carcinoma (la/mUC), and therefore we explored how patients with la/mUC value different attributes of first-line treatments.
Methods: An online preference survey and multidimensional thresholding (MDT) exercise were developed following a targeted literature review and qualitative interviews with physicians, patients with la/mUC, and their caregivers. Treatment attributes included two benefits (overall response rate [ORR], pain related to bladder cancer [scored 0-100; 100 being the worst pain possible]) and four treatment-related risks (peripheral neuropathy, severe side effects, mild to moderate nausea, mild to moderate skin reactions). A Dirichlet regression was used to estimate average preference weights. Marginal utility and the reduction in ORR that patients would accept in exchange for a 10-point decrease or a 10% decrease in other attributes were calculated.
Results: A total of 100 patients were recruited and self-completed the survey and MDT. Mean patient age was 64.9 years (standard deviation, 7.6), 54% were female, and 38% identified as white. All included treatment attributes had a statistically significant impact on preferences. Changes in ORR had the largest impact, followed by cancer-related pain and treatment-related risks. Patients were willing to accept an 8.4% decrease in ORR to reduce their pain level by 10 points or a 7.8% decrease in ORR to reduce the risk of peripheral neuropathy by 10%. For a 10% decrease in severe side effects, mild to moderate nausea, or skin reaction, patients would accept decreases in ORR of 5.5%, 3.7%, or 3.4%, respectively.
Conclusions: Of the attributes tested, changes in ORR were most important to patients. Patients made tradeoffs between treatment attributes indicating that a lower ORR may be acceptable for an improvement in other attributes such as reduced cancer-related pain or the risk of treatment-related adverse events.
(© 2024. The Author(s).)
Databáze: MEDLINE
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