Patient preference for first-line treatments of ALK-positive metastatic non-small cell lung cancer: a discrete choice experiment

For patients with ALK-positive metastatic NSCLC, targeted therapy with ALK inhibitors is a recommended first-line treatment. Three generations of ALK-TKIs are now available, varying in efficacy and side effects. It is important to identify patients’ priorities and the benefit-risk trade-offs among potential treatment options. A discrete choice experiment was conducted in China to elicit the preferences of patients with ALK-positive advanced NSCLC and their family members (both decision-makers for the treatment). Respondents completed multiple hypothetical treatment profiles characterized by 7 attributes. Data were analyzed using mixed logit model. Analysis of minimum acceptable benefit and scenario simulation were conducted. Subgroup analysis was also employed. Respondents (N = 115) placed most value on PFS (RI = 58.13%), followed by reduced risk of brain metastasis (RI = 13.04%). Attributes of side effects were considered less critical. When the degree of side effects was altered from mild to moderate, respondents require a minimum increase of 5.34 months in PFS as compensation. Scenario analysis estimated 97.06% of respondents would endorse the new treatment option if the PFS was improved from 36 months to 60 months. Subgroup analysis revealed that the preference patterns of patients and their families are similar. However, respondents’ preferences exhibit heterogeneity for patients with different brain metastasis status, age, and annually household income. This is currently among the first patient preference DCE study for first-line treatments of ALK-positive mNSCLC. Understanding patients’ preferences can enhance shared decision-making between patients and clinicians, fostering personalized prophylactic treatment plans that may optimize adherence and improve clinical outcomes.