Oncologists’ preferences for first-line treatment of ALK-positive metastatic NSCLC in the United States: a discrete choice experiment

Tradeoffs between efficacy, safety, and administration may influence decision-making for first-line (1L) treatments for ALK+ mNSCLC. This study explored heterogeneity in provider preferences. A survey of US oncologists treating ≥1 ALK+ mNSCLC patient was conducted June–August 2024. Participants answered 12 questions comparing 1 L profiles characterized by eight treatment attributes for patients without brain metastases. Attributes included 3-year PFS, intracranial duration of response (iDOR), 16-month risk of edema, myalgia, or cognitive effects, grade ≥3 interstitial lung disease/pneumonitis, 2 L+ treatment options, and administration. Relative attribute importance (RAI) (0–100%) was calculated for aggregate efficacy and safety attributes. Latent class analysis (LCA) explored preference heterogeneity and differences in respondent characteristics. In total, 201 oncologists completed the discrete choice experiment. Oncologists emphasized the efficacy over safety (RAI = 47.0% vs 39.0%). LCA identified two classes, placing similar importance on efficacy (RAI = 44.5% vs 48.2%) and safety (RAI = 39% vs 41.2%), but preferring different levels in five attributes. Class 1 oncologists (61%) preferred 3-year PFS of 64% over 43–46%, while Class 2 oncologists (39%) did not differentiate. Conversely, Class 2 focused on iDOR. We identified two oncologist groups with distinct preferences for treatment attributes. Given various 1 L ALK+ mNSCLC treatments, clinical decision-making balances multiple objectives. We surveyed 201 US-based oncologists to understand what characteristics of different treatment options for ALK+ metastatic non-small cell lung cancer impact clinical decisions. We asked about the role each treatment’s efficacy, side effects, and administration play in treatment choices, using a Discrete Choice Experiment approach. We found that oncologists valued efficacy over a treatment’s side effect profile and that there were two distinct groups of oncologists with respect to treatment preferences. While both groups placed similar value on efficacy outcomes, one group’s clinical decisions were largely driven by a treatment’s ability to slow disease progression, while the other group’s clinical decision depended on a treatment’s ability to protect the patient from developing brain metastases. This suggests that the treatment decisions for patients with ALK+ metastatic non-small cell lung cancer are complex and that physicians balance multiple-treatment objectives in their choice of therapy.疗效、安全性与给药方式之间的权衡，可能会影响间变性淋巴瘤激酶阳性转移性非小细胞肺癌（ALK+ mNSCLC）一线治疗方案的决策制定。本研究旨在探讨医疗服务提供者的偏好异质性。研究于2024年6月至8月期间开展，调查对象为曾诊治过至少1例ALK+ mNSCLC患者的美国肿瘤医师。参与者需回答12个问题，对比无脑转移患者的8项治疗属性对应的一线治疗方案特征。所考察的治疗属性包括：3年无进展生存期（Progression-Free Survival, PFS）、颅内应答持续时间（intracranial duration of response, iDOR）、16个月时的水肿、肌痛或认知不良反应风险、≥3级间质性肺疾病/肺炎发生率、二线及以上治疗选择，以及给药方式。研究计算了整体疗效与安全性属性的相对重要性评分（relative attribute importance, RAI），评分范围为0~100%。潜类别分析（Latent Class Analysis, LCA）用于探究偏好异质性以及调查对象的特征差异。最终共有201名肿瘤医师完成了此项离散选择实验。肿瘤医师更看重疗效而非安全性，二者的相对重要性评分分别为47.0%与39.0%。潜类别分析识别出两类医师群体，二者对疗效（相对重要性评分分别为44.5%与48.2%）和安全性（相对重要性评分分别为39%与41.2%）的重视程度相近，但在5项治疗属性的偏好等级上存在差异。第一类医师（占比61%）更倾向于3年无进展生存期为64%的治疗方案，而非43%~46%的方案，而第二类医师（占比39%）则无明显偏好差异。与之相反，第二类医师更关注颅内应答持续时间。本研究识别出两类对治疗属性存在不同偏好的肿瘤医师群体。面对ALK+ mNSCLC多样的一线治疗方案，临床决策需平衡多重目标。本研究共调查了201名美国肿瘤医师，旨在明确ALK+转移性非小细胞肺癌不同治疗方案的哪些特征会影响临床决策。研究采用离散选择实验法，调研了治疗疗效、不良反应与给药方式在治疗方案选择中所起到的作用。研究结果显示，肿瘤医师更看重治疗疗效而非不良反应特征，且在治疗偏好上存在两类截然不同的医师群体。尽管两类医师对疗效结局的重视程度相近，但其中一类医师的临床决策主要受治疗延缓疾病进展的能力影响，而另一类医师的决策则取决于治疗预防患者发生脑转移的能力。这表明，ALK+转移性非小细胞肺癌患者的治疗决策十分复杂，临床医师在选择治疗方案时需平衡多重治疗目标。