Patient and Physician Preferences for Add-On Systemic Therapy to Transarterial Chemoembolization for Hepatocellular...

Transarterial chemoembolization (TACE) is the primary treatment for intermediate-stage hepatocellular carcinoma (HCC). Synergistic effects are expected by adding recently developed systemic therapies onto TACE. We investigated patient and physician preferences for this treatment approach.

Preferences of patients with HCC who underwent TACE and physicians treating HCC were assessed using a discrete choice experiment. Eighteen hypothetical treatment profiles were set based on seven attributes, including survival outcomes, treatment burden, and side effects, with two or three levels. A mixed-logit model estimated the preference weights for each attribute level.

The 85 HCC patients surveyed had a median age of 69 (interquartile range 59-75) years. Most were male (84.7% [72/85]). Most physicians (70.4% [69/98]) were ≥40 years old, and 93.9% (92/98) were male. Both patients and physicians showed the largest positive preferences for 5-year overall survival (OS) {preference weight (95% confidence interval [CI]) 3.41 (2.85, 3.97) and 4.84 (3.90, 5.79), p < 0.001, respectively}, relative to 2-year OS. Following this, patients preferred minimizing the risk of fatigue with negative preferences (95% CI) for a 50% risk relative to a 10% risk (-0.84 [-1.24, -0.43], p < 0.001), and physicians preferred extended time to progression (TTP) from 6 months to 2 years (1.39 [0.82, 1.95], p < 0.001). Physicians, but not patients, exhibited a significant negative preference (95% CI) for a 40% increase in the risk of immune-related side effects (-1.03 [-1.67, -0.39], p = 0.002, and -0.41 [-0.84, 0.02], p = 0.063, respectively). Preferences varied depending on patient and physician characteristics.

OS was the most important factor for both patients and physicians in TACE-based treatment for HCC, with fatigue the second largest preference factor for patients and TTP for physicians. Understandings of immune-related side effects seemed to vary among participants. These findings enhance patient-physician communication and shared decision-making.