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. 2025 Mar 3;20(1):16-26.
doi: 10.1159/000543320. Epub 2025 Jan 8.

Patient Preferences for HR+/HER2- Early Breast Cancer Adjuvant Treatment: A Multicountry Discrete Choice Experiment

Victoria Harmer  1 , Cathy Ammendolea  2   3 , Mandy Ryan  4 , Frances Boyle  5 , Gustavo Werutsky  6   7 , Dina El Mouzain  8 , Deborah A Marshall  9 , Caitlin Thomas  10 , Sebastian Heidenreich  10 , Hui Lu  10 , Nicolas Krucien  10 , Juan Mora Payan  11 , Dawn Aubel  11 , Andriy Danyliv  12 , Purnima Pathak  11 , Nadia Harbeck  13
Affiliations

Patient Preferences for HR+/HER2- Early Breast Cancer Adjuvant Treatment: A Multicountry Discrete Choice Experiment

Victoria Harmer et al. Breast Care (Basel). .

Abstract

Introduction: More adjuvant treatment options are becoming available for hormone receptor-positive/human epidermal growth factor receptor 2-negative (HR+/HER2-) early breast cancer (EBC) based on results of clinical trials. This study quantified the importance of different attributes of EBC adjuvant therapies to patients and the benefit-risk tradeoffs patients were willing to make.

Methods: Women with HR+/HER2- EBC completed an online discrete choice experiment (DCE) survey; the design was informed by clinical data, qualitative interviews (n = 40), and pre-testing interviews (n = 40). Participants (pts) made 10 choices between pairs of hypothetical treatments described by varying levels of 6 attributes. DCE data were analyzed using a correlated mixed logit model. Relative attribute importance scores captured the impact of each attribute across clinically relevant ranges. Benefit-risk tradeoffs were captured as the minimum improvements in 5-year invasive disease-free survival (iDFS) that pts would require to tolerate increases in therapy-associated adverse event (AE) risks.

Results: A total of 866 patients from the USA, France, Spain, Canada, the UK, Germany, South Korea, and Australia completed the DCE (mean age: 57.7 years; 76% postmenopausal; 29% stage I disease, 55% stage II, 16% stage III). Improved 5-year iDFS (75.4-82.7% range; associated with combination regimens [CRs] vs. endocrine therapy [ET] alone) contributed the most to treatment preferences (clinically relevant relative attribute importance: 38.4%), followed by reduced risks of venous thromboembolic events (VTEs) (20.4%), neutropenia (20.3%), and diarrhea (15.0%). Treatment type + duration (3.7%) and fatigue (2.3%) were less important. Pts required the largest improvement in 5-year iDFS (3.9%) to tolerate increased risks of VTE (0.7%-2.5%) or neutropenia (5.6%-46%); willingness to accept tradeoffs depended on the AE. Preference heterogeneity was observed across subgroups, but 5-year iDFS improvement was consistently the most impactful on treatment choice in all subgroups.

Conclusion: A multicountry sample of patients most valued adjuvant therapies with higher 5-year iDFS and may therefore prefer CRs over ET alone. The value of CRs depends on their specific safety profiles, and shared decision-making should consider this to select treatment options that align with individual preferences.

Keywords: Adjuvant treatment; CDK4/6 inhibitor; Discrete choice experiment; Early breast cancer; Patient preference.

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Conflict of interest statement

V.H.: personal fees for consulting, lectures, honoraria, travel expenses from Lilly, Medscape, Novartis, ArticulateScience, AstraZeneca, and Exact Science. C.A.: grants for CBCN advocacy and education funding and honoraria from Novartis. F.B.: advisory boards for Novartis, Lilly, Pfizer, Roche, MSD, and Gilead. G.W.: honoraria from Novartis. M.R. and D.E.M.: nothing to disclose. D.A.M.: travel expenses for meeting attendance from ISPOR and Illumina; honorarium from ISPOR; fees for consulting paid to institution from Analytica and Novartis; research grants to institution from Canadian Institutes of Health Research, Genome Canada, Arthritis Society, and Alberta Innovates; and support by the Svare Chair in Health Economics. C.T. and H.L.: employees of Evidera by Thermo Fisher Scientific, which received funding by Novartis to conduct the work reported in this manuscript. S.H. and N.K.: employees of Evidera by Thermo Fisher Scientific, which received funding by Novartis to conduct the work reported in this manuscript; minority shareholders of Thermo Fisher Scientific as part of employment with Evidera. J.M.P., D.A., A.D., and P.P.: employees and minority shareholders of Novartis, which funded the work described in this manuscript. N.H.: personal fees for consulting and lectures from AstraZeneca, Daiichi Sankyo, MSD, Pierre Fabre, Roche, Sandoz/Hexal, Amgen, Exact Sciences, Gilead, and Seagen.

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