Mansfield C, Botha W, Vondeling GT, Klein K, Wang K, Singh J, Hackshaw MD. Patient preferences for features of HER2-targeted treatment of advanced or metastatic breast cancer: a discrete-choice experiment study. Breast Cancer. 2023 Jan;30(1):23-35. doi: 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 months to 26 months; change from no diarrhea to severe diarrhea was 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.

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