Highlights
- •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.
Abstract
Background
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.
Results
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.
Conclusion
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.
Keywords
Abbreviations:
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
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References
- And the Association of Population-based Cancer Registries in Germany (ed.).Cancer in Germany in 2015/2016, Berlin2020
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: https://www.krebsdaten.de/Krebs/EN/Database/databasequery_step1_node.html. Accessed: August 13,2020.
- Projections of cancer incidence and cancer-related deaths in Germany by 2020 and 2030.Cancer Med. 2016; 5: 2649-2656
- ESMO consensus guidelines for the management of patients with metastatic colorectal cancer.Ann Oncol. 2016; 27: 1386-1422
- S3 guideline - colorectal carcinoma.Z Gastroenterol. 2017; 55: 1344-1498
Leitlinienprogramm Onkologie. S3-Leitlinie Kolorektales Karzinom. Langversion 2.1. – Januar. 2019. AWMF-Registernummer: 021/007OL. Available at: https://www.awmf.org/uploads/tx_szleitlinien/021-007OLl_S3_Kolorektales-Karzinom-KRK_2019-01.pdf. Accessed: August 4, 2021.
European Medicines Agency. Vectibix - summary of product characteristics. Available at: https://www.ema.europa.eu/en/documents/product-information/vectibix-epar-product-information_en.pdf. Accessed: August 4, 2021.
European Medicines Agency. Erbitux - summary of product characteristics. Available at: https://www.ema.europa.eu/en/documents/product-information/erbitux-epar-product-information_en.pdf. Accessed: August /04/2021.
European Medicines Agency. Avastin - summary of product characteristics. Available at: https://www.ema.europa.eu/en/documents/product-information/avastin-epar-product-information_en.pdf. Accessed: August 4, 2021.
- 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
- 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
- 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
- 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
- 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
- Panitumumab-FOLFOX4 treatment and RAS mutations in colorectal cancer.N Engl J Med. 2013; 369: 1023-1034
- 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
- 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
- Patient preference and decision-making for initiating metastatic colorectal cancer medical treatment.J Cancer Res Clin Oncol. 2016; 142: 699-706
- 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
- A protocol for a discrete choice experiment: understanding patient medicine preferences for managing chronic non-cancer pain.BMJ Open. 2019; 9e027153
- 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
- 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
OnkoZert. OnkoZert. Available at: https://www.onkozert.de/en/. 2020. Accessed: August 4, 2021.
- 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
- Treatment satisfaction and adherence to oral chemotherapy in patients with cancer.J Oncol Pract. 2017; 13: e474-e485
- A meta-analysis of the association between adherence to drug therapy and mortality.BMJ. 2006; 333: 15
Article info
Publication history
Published online: December 20, 2021
Accepted:
December 16,
2021
Received in revised form:
December 10,
2021
Received:
April 9,
2021
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
