A comprehensive study examining treatment preferences in ALK-positive non-small cell lung cancer (ALK+ NSCLC) has revealed important insights into how patients and caregivers balance treatment benefits against potential risks. The research, presented at the 2025 American Society of Clinical Oncology (ASCO) Annual Meeting, highlights significant differences in priorities between patients and their caregivers when making treatment decisions.
Study Design and Methodology
Researchers led by Christopher Danes, PhD, scientific director of Global Medical Affairs Oncology at Takeda Oncology, conducted an online discrete choice experiment involving 205 ALK+ NSCLC patients and 125 caregivers. Participants were repeatedly asked to choose between two hypothetical treatments characterized by seven benefit/risk attributes, including 3-year progression-free survival (PFS) and various adverse events.
The comprehensive approach included evaluating existing literature, examining clinical trial data, and conducting an initial survey to gain a clear understanding of the various factors influencing treatment decisions.
Key Findings on Treatment Priorities
The results demonstrated that both patients and caregivers overwhelmingly prioritized 3-year progression-free survival as the most important factor in treatment selection. However, while adverse events were considered less important overall, most participants showed willingness to accept reductions in PFS to minimize certain risks.
Specifically, patients were willing to trade 3.9-8.7% of 3-year PFS to reduce risks including cognitive and mood effects, abnormal laboratory results, and lung complications. Caregivers demonstrated similar willingness to make trade-offs for some risks, though not for all adverse events.
Notably, approximately 30% of both patients and caregivers based their treatment choices solely on progression-free survival, while a subset of caregivers were unwilling to trade any treatment benefit for reduced risks.
Divergent Perspectives on Adverse Events
The study revealed striking differences in how patients and caregivers perceive and prioritize various adverse events. Laboratory abnormalities emerged as a particularly prominent concern for caregivers, which researchers found initially surprising but ultimately logical.
"The concern stems from the fact that if a patient experiences a lab abnormality, there is a strong possibility that their medication dosage will be reduced. This directly impacts the drug's potential efficacy, which is a major worry for both patients and those caring for them," Danes explained.
Weight gain presented another example of divergent priorities. While patients found weight gain incredibly impactful from their perspective, caregivers often ranked it as very low in terms of concern. Similarly, caregivers generally ranked myalgia as having relatively low impact, whereas patients considered muscle soreness a higher concern due to its significant effect on daily quality of life.
Clinical Implications for Treatment Discussions
The research underscores the complexity of treatment decision-making in ALK+ NSCLC, where therapies are often long-term commitments requiring careful consideration of multiple factors. The findings suggest that adverse event tables, while valuable, don't always capture the day-to-day impact of individual adverse events on patients' lives.
"Through this [experiment], you can kind of get a sense of how impactful those [adverse effects] are to them. And so looking at it from both the patient and caregivers perspective is really important, because sometimes what a patient experiences and what a caregiver observes are 2 different things," Danes noted.
The study emphasizes that including both patients and caregivers in the decision-making process provides valuable perspectives, as they can observe different aspects of what's happening and what's truly impactful in the treatment experience.
Recommendations for Clinical Practice
The researchers conclude that open discussions between physicians, patients, and caregivers are essential to consider individual preferences regarding the balance between treatment benefits and potential risks. This detailed understanding of patient and caregiver concerns empowers physicians to have more targeted and effective discussions, ultimately leading to better care outcomes.
The study's findings suggest that healthcare providers should recognize that daily experiences with adverse events can significantly affect patients' quality of life in ways that might not be immediately apparent to outside observers, highlighting the need for comprehensive communication strategies in ALK+ NSCLC treatment planning.
