Patient preferences for features of HER2-targeted treatment of advanced or metastatic breast cancer
A discrete-choice experiment study
Mansfield, C., Botha, W., Vondeling, G. T., Klein, K., Wang, K., Singh, J., & Hackshaw, M. D. (2023). Patient preferences for features of HER2-targeted treatment of advanced or metastatic breast cancer: A discrete-choice experiment study. Breast Cancer, 30(1), 23-35. Advance online publication. https://doi.org/10.1007/s12282-022-01394-6
BACKGROUND: We aimed to quantify patients' benefit-risk preferences for attributes associated with human epidermal growth factor receptor 2 (HER2)-targeted breast cancer treatments and estimate minimum acceptable benefits (MABs), denominated in additional months of progression-free survival (PFS), for given treatment-related adverse events (AEs).
METHODS: We conducted an online discrete-choice experiment (DCE) among patients with self-reported advanced/metastatic breast cancer in the United States, United Kingdom, and Japan (N = 302). In a series of nine DCE questions, respondents chose between two hypothetical treatment profiles created by an experimental design. Profiles were defined by six attributes with varying levels: PFS, nausea/vomiting, diarrhea, liver function problems, risk of heart failure, and risk of serious lung damage and infections. Data were analyzed using an error component random-parameters logit model.
RESULTS: Among the attributes, patients placed the most importance on a change in PFS from 5 to 26 months; change from no diarrhea to severe diarrhea was the least important. Avoiding a 15% risk of heart failure had the largest MAB (5.8 additional months of PFS), followed by avoiding a 15% risk of serious lung damage and infections (4.6 months), possible severe liver function problems (4.2 months), severe nausea/vomiting (3.7 months), and severe diarrhea (2.3 months) compared with having none of the AEs. The relative importance of 21 additional months of PFS (increasing from 5 to 26 months) increased for women with HER2-negative disease and those with children.
CONCLUSIONS: Patients valued PFS gain higher than the potential risk of AEs when deciding between hypothetical breast cancer treatments.