Oncologists' preferences for first-line treatment of ALK-positive metastatic NSCLC in the United States: a discrete choice experiment.

OBJECTIVE

Tradeoffs between efficacy, safety, and administration may influence decision-making for first-line (1L) treatments for ALK+ mNSCLC. This study explored heterogeneity in provider preferences.

METHODS

A survey of US oncologists treating ≥1 ALK+ mNSCLC patient was conducted June-August 2024. Participants answered 12 questions comparing 1 L profiles characterized by eight treatment attributes for patients without brain metastases. Attributes included 3-year PFS, intracranial duration of response (iDOR), 16-month risk of edema, myalgia, or cognitive effects, grade ≥3 interstitial lung disease/pneumonitis, 2 L+ treatment options, and administration. Relative attribute importance (RAI) (0-100%) was calculated for aggregate efficacy and safety attributes. Latent class analysis (LCA) explored preference heterogeneity and differences in respondent characteristics.

RESULTS

In total, 201 oncologists completed the discrete choice experiment. Oncologists emphasized the efficacy over safety (RAI = 47.0% vs 39.0%). LCA identified two classes, placing similar importance on efficacy (RAI = 44.5% vs 48.2%) and safety (RAI = 39% vs 41.2%), but preferring different levels in five attributes. Class 1 oncologists (61%) preferred 3-year PFS of 64% over 43-46%, while Class 2 oncologists (39%) did not differentiate. Conversely, Class 2 focused on iDOR.

CONCLUSION

We identified two oncologist groups with distinct preferences for treatment attributes. Given various 1 L ALK+ mNSCLC treatments, clinical decision-making balances multiple objectives.