Assessment of Metastatic Colorectal Cancer Patients’ Preferences for Biologic Treatments in Germany Using a Discrete Choice Experiment

Published:December 20, 2021DOI:


      • Treatment preference analysis in German metastatic colorectal cancer patients.
      • Main driver for treatment decision was efficacy, followed by safety and frequency.
      • Overall survival was the main driver for treatment choice in all subgroups.
      • Risk of severe skin toxicities was more important in women than men.
      • Risk of side effects more important to those with prior experience of side effects.



      Current treatment regimens for metastatic colorectal cancer (mCRC) include biologics such as epidermal growth factor receptor and vascular endothelial growth factor inhibitors, which have specific side-effect profiles. There is a lack of information on mCRC patient preference in Germany regarding biologics in combination with chemotherapy. This study aims to identify German mCRC patients’ preference for these treatments

      Patients and Methods

      This was a multicenter cross-sectional discrete choice experiment (DCE). Data were collected using electronic case report forms and structured phone interviews. DCE attributes were related to efficacy, side effects, frequency of administration, and distance to treating physicians’ practice. Patients’ characteristics and choices were analyzed descriptively. Choice data was modeled using a random utility maximization framework.


      All attributes, except distance to treating physicians’ practice, had a significant impact on patients’ decision. The most important driver of patients’ treatment decision was overall survival, followed by safety-related attributes and frequency of administration. Overall survival was the main driver in all subgroups analyzed. Risk of severe skin toxicities was more important to women, than men. In patients with prior experience of side effects, the risk of side effects accounted for 45% of a patient's decision, compared to 35% in those without prior experience.


      Overall survival remains the most important driver in mCRC patients’ preferences for biologic treatment in combination with chemotherapy. Attributes related to safety were less important to patients when considering their treatment decision. These results indicate that understanding patient preferences may lead to increased treatment compliance.



      AEs (adverse events), CRC (colorectal cancer), DCE (discrete choice experiment), ECOG (Eastern Cooperative Oncology Group), EGFR (epidermal growth factor receptor), GI (gastrointestinal), mCRC (metastatic colorectal cancer), ORR (overall response rate), OS (overall survival), PFS (progression-free survival), RAS (Rat sarcoma), SD (standard deviation), SmPC (summary of product characteristics), VEGF (vascular endothelial growth factor), WT (wild-type)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Clinical Colorectal Cancer
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Robert Koch Institute (ed.)
        And the Association of Population-based Cancer Registries in Germany (ed.).
        Cancer in Germany in 2015/2016, Berlin2020
      1. Database Query with estimates for cancer incidence. prevalence and survival in Germany, based on data of the population based cancer registries. mortality data provided by the Federal Statistical Office. 2019. Available at: Accessed: August 13,2020.

        • Quante AS
        • Ming C
        • Rottmann M
        • et al.
        Projections of cancer incidence and cancer-related deaths in Germany by 2020 and 2030.
        Cancer Med. 2016; 5: 2649-2656
        • Van Cutsem E
        • Cervantes A
        • Adam R
        • et al.
        ESMO consensus guidelines for the management of patients with metastatic colorectal cancer.
        Ann Oncol. 2016; 27: 1386-1422
        • Schmiegel W
        • Buchberger B
        • Follmann M
        • et al.
        S3 guideline - colorectal carcinoma.
        Z Gastroenterol. 2017; 55: 1344-1498
      2. Leitlinienprogramm Onkologie. S3-Leitlinie Kolorektales Karzinom. Langversion 2.1. – Januar. 2019. AWMF-Registernummer: 021/007OL. Available at: Accessed: August 4, 2021.

      3. European Medicines Agency. Vectibix - summary of product characteristics. Available at: Accessed: August 4, 2021.

      4. European Medicines Agency. Erbitux - summary of product characteristics. Available at: Accessed: August /04/2021.

      5. European Medicines Agency. Avastin - summary of product characteristics. Available at: Accessed: August 4, 2021.

        • Schwartzberg LS
        • Rivera F
        • Karthaus M
        • et al.
        PEAK: a randomized, multicenter phase II study of panitumumab plus modified fluorouracil, leucovorin, and oxaliplatin (mFOLFOX6) or bevacizumab plus mFOLFOX6 in patients with previously untreated, unresectable, wild-type KRAS exon 2 metastatic colorectal cancer.
        J Clin Oncol. 2014; 32: 2240-2247
        • Heinemann V
        • von Weikersthal LF
        • Decker T
        • et al.
        FOLFIRI plus cetuximab vs. FOLFIRI plus bevacizumab as first-line treatment for patients with metastatic colorectal cancer (FIRE-3): a randomised, open-label, phase 3 trial.
        Lancet Oncol. 2014; 15: 1065-1075
        • Venook AP
        • Niedzwiecki D
        • Lenz HJ
        • et al.
        Effect of first-line chemotherapy combined with cetuximab or bevacizumab on overall survival in patients with KRAS wild-type advanced or metastatic colorectal cancer: a randomized clinical trial.
        JAMA. 2017; 317: 2392-2401
        • Heinemann V
        • Rivera F
        • O'Neil BH
        • et al.
        A study-level meta-analysis of efficacy data from head-to-head first-line trials of epidermal growth factor receptor inhibitors versus bevacizumab in patients with RAS wild-type metastatic colorectal cancer.
        Eur J Cancer. 2016; 67: 11-20
        • Holch JW
        • Ricard I
        • Stintzing S
        • Modest DP
        • Heinemann V
        The relevance of primary tumour location in patients with metastatic colorectal cancer: a meta-analysis of first-line clinical trials.
        Eur J Cancer. 2017; 70: 87-98
        • Douillard JY
        • Oliner KS
        • Siena S
        • et al.
        Panitumumab-FOLFOX4 treatment and RAS mutations in colorectal cancer.
        N Engl J Med. 2013; 369: 1023-1034
        • Boeckx N
        • Koukakis R
        • Op de Beeck K
        • et al.
        Primary tumor sidedness has an impact on prognosis and treatment outcome in metastatic colorectal cancer: results from two randomized first-line panitumumab studies.
        Ann Oncol. 2017; 28: 1862-1868
        • Peeters M
        • Price TJ
        • Cervantes A
        • et al.
        Randomized phase III study of panitumumab with fluorouracil, leucovorin, and irinotecan (FOLFIRI) compared with FOLFIRI alone as second-line treatment in patients with metastatic colorectal cancer.
        J Clin Oncol. 2010; 28: 4706-4713
        • Fu AZ
        • Graves KD
        • Jensen RE
        • Marshall JL
        • Formoso M
        • Potosky AL
        Patient preference and decision-making for initiating metastatic colorectal cancer medical treatment.
        J Cancer Res Clin Oncol. 2016; 142: 699-706
        • Reed Johnson F
        • Lancsar E
        • Marshall D
        • et al.
        Constructing experimental designs for discrete-choice experiments: report of the ISPOR conjoint analysis experimental design good research practices task force.
        Value Health. 2013; 16: 3-13
        • Shanahan M
        • Larance B
        • Nielsen S
        • Cohen M
        • Schaffer M
        • Campbell G
        A protocol for a discrete choice experiment: understanding patient medicine preferences for managing chronic non-cancer pain.
        BMJ Open. 2019; 9e027153
        • Gonzalez JM
        • Ogale S
        • Morlock R
        • et al.
        Patient and physician preferences for anticancer drugs for the treatment of metastatic colorectal cancer: a discrete-choice experiment.
        Cancer Manag Res. 2017; 9: 149-158
        • Wong XY
        • Lim AQJ
        • Shen QY
        • et al.
        Patient preferences and predicted relative uptake for targeted therapies in metastatic colorectal cancer: a discrete choice experiment.
        Curr Med Res Opin. 2020; 36: 1677-1686
      6. OnkoZert. OnkoZert. Available at: 2020. Accessed: August 4, 2021.

        • Guren TK
        • Thomsen M
        • Kure EH
        • et al.
        Cetuximab in treatment of metastatic colorectal cancer: final survival analyses and extended RAS data from the NORDIC-VII study.
        Br J Cancer. 2017; 116: 1271-1278
        • Jacobs JM
        • Pensak NA
        • Sporn NJ
        • et al.
        Treatment satisfaction and adherence to oral chemotherapy in patients with cancer.
        J Oncol Pract. 2017; 13: e474-e485
        • Simpson SH
        • Eurich DT
        • Majumdar SR
        • et al.
        A meta-analysis of the association between adherence to drug therapy and mortality.
        BMJ. 2006; 333: 15