Review of Stakeholder Preferences for Non-Metastatic Castration-Resistant Prostate Cancer Treatments

Abstract

The goals of treating non-metastatic castration-resistant prostate cancer (nmCRPC) patients are to delay metastasis and prolong life, while maintaining the quality of patients’ survival. The recent approval of second-generation androgen-receptor inhibitors (SGARIs) in the United States has expanded the treatment landscape for nmCRPC. Large-scale randomized controlled trials showed that SGARI treatment options have similar efficacy, but different safety profiles. Two recent discrete choice experiment (DCE) studies conducted in the United States, evaluated the benefit-risk tradeoffs of patients, caregivers and physicians for nmCRPC treatments. The aim of this review is to summarize these two studies and highlight differences in the preferences among these three stakeholder groups with respect to adverse events (AEs) of specific interest in nmCRPC. Both DCE studies included 5 AE attributes: frequency or level of severity of fatigue, skin rash, cognitive impairment, risk of serious fracture, risk of serious fall. Survey results from patients (n=143), caregivers (n=149), and physicians (n=74 oncologists, n=75 urologists) were analyzed using random parameters logit models generating preference weights for each attribute level. AE reduction was more important than improving OS for physicians and even more prominently for patients and caregivers. As government healthcare agencies, globally, continue integrating patient feedback and evidence into their decision-making processes, the role of preference methodology in generating such evidence, may be expected to grow.