Patient and Physician Preferences in Treating Metastatic Melanoma in the United States: A Discrete Choice Experiment
Michael A. Postow, Jennell Palaia, Gabriela Burgos, Marc DeCongelio, Zander Pittman, Neelanzana Paudel, Ryan Honomichl, Kushal Modi, Divya Patel, Dana Deighton, Jennifer L. HayBackground:
Although current National Comprehensive Cancer Network guidelines recommend immunotherapies for advanced melanoma, variability in patients’ risk–benefit profiles and treatment characteristics makes treatment selection challenging. Given these differences, we aimed to assess patient and physician preferences for treatment attributes in advanced melanoma.
Methods:
This cross-sectional study included 2 surveys: one administered to patients with self-reported unresectable stage III or IV melanoma and another to treating physicians. A discrete choice experiment (DCE) was used to elicit preferences and the relative importance (RI) of treatment attributes of efficacy (progression-free survival, overall survival [OS], objective response rate), safety (grade 3/4 treatment-related adverse events [TRAEs], endocrine AEs, discontinuation due to TRAEs), and dosing. The DCE included 12 tasks, each with 2 options with varying levels. The same DCE was used across both surveys, with language tailored to each participant group. A hierarchical Bayesian model was used to estimate preference weights for each level.
Results:
Overall, 75 patients (mean age, 44.8 y; male, 65%) and 75 physicians (mean age, 45.5 y; male, 76%) were included. For both groups, improvement in safety attributes (overall RI, patients: 49%; physicians: 49%) was more important than improvement in efficacy attributes (overall RI, patients: 35%; physicians: 41%). Both groups were willing to accept a decrease in OS from 65% to 55% for a decrease in grade 3/4 TRAEs (60% to 10%) and discontinuation due to TRAEs (40% to 7%), respectively. Endocrine AEs were considered the least important.
Conclusion:
Patients and physicians prioritized safety over efficacy when efficacy differences were minimal in selecting first-line treatment for advanced melanoma. By eliciting preferences from these groups, this study identifies the treatment attributes most valued by each group and informs patient-centered treatment recommendations and benefit–risk assessment.