Patient and caregiver priorities of treatment characteristics influencing preferences for tyrosine kinase inhibitors in anaplastic lymphoma kinase-positive metastatic non-small cell lung cancer.

INTRODUCTION

New-generation tyrosine kinase inhibitors (TKIs) for anaplastic lymphoma kinase rearrangement (ALK + ) non-small cell lung cancer (NSCLC) vary in treatment attributes (e.g., efficacy and adverse events [AEs]). This study quantified how patients and caregivers prioritize TKI-specific attributes on treatment choice and the variability in treatment preferences.

METHODS

US patients with stage IV ALK+NSCLC and caregivers completed online discrete choice experiment (DCE) tasks, in which they chose between two hypothetical TKIs described by seven benefit and risk attributes. A latent class logit model, which classified participants based on preferences, was used to estimate each attribute's relative contribution to preference and maximum acceptable loss in the chance of 3-year progression-free survival (PFS) to reduce AE risks.

RESULTS

Two distinct preference patterns were identified among 205 patients and 125 caregivers, described using interpretive labels. Balanced Traders (37.1% of patients, 48.8% of caregivers) valued both risk reduction and 3-year PFS, whereas Benefit Maximizers (47.8% of patients, 36.8% of caregivers) primarily valued improving 3-year PFS. Others (15.1% of patients, 14.4% of caregivers) appeared less engaged in making choices. Balanced Traders were willing to accept a greater loss in the chance of 3-year PFS (patients: up to 22.1%; caregivers: up to 25.8%) to mitigate AEs (e.g., any grade cognitive/mood effects, grade ≥ 3 abnormal lab results, and grade ≥ 3 weight gain) than Benefit Maximizers (patients: up to 6.2%; caregivers: up to 5.5%).

CONCLUSION

Preference heterogeneity highlights the need to incorporate how patients and caregivers, particularly those risk-sensitive to specific AEs, balance benefits and risks into shared treatment decision-making.