Patient preferences for stages II-IV melanoma treatments in the UK: results from a cross-sectional study

To understand patient preferences for treatment attributes in adjuvant and metastatic melanoma in the UK.

Patients with stages II-IV melanoma completed an online survey from November 2022 to February 2023 comprising two discrete choice experiments (DCE) exploring efficacy, safety, and dosing regimen.

Out of 104 respondents, 100 and 102 patients completed DCEs for adjuvant (Adj-DCE) and metastatic (Met-DCE) settings, respectively. 4-year relapse-free survival (RFS) for Adj-DCE (33%), and 4-year overall survival (OS) for Met-DCE (40%) had the highest relative attribute importance (RI), followed by risk of grade ≥3 adverse events (29% versus 26%, respectively). Patients with advanced melanoma or BRAF mutation had significantly higher RI for RFS and OS.

Patients, especially those with advanced melanoma or BRAF mutation, perceive efficacy as the most important factor in determining choice of treatment.ARTICLE HIGHLIGHTSIn the UK, melanoma is the 5^th most common cancer with around 19,921 newly diagnosed cases in 2022. Fortunately, treatment options for patients with melanoma have expanded significantly over the past few years. Each of these new therapies carries a different benefit-to-risk profile and varies with regard to different aspects of patient convenience.The aim of this study was to understand patient preferences for adjuvant and metastatic treatment attributes in stage II/III and stage IV melanoma in the UK and to determine predictive factors for treatment preferences in different subpopulations.A discrete-choice experiment (DCE) was conducted via an online quantitative treatment preference survey to elicit patients' relative preferences for treatment attributes, including safety, dosing regimen, and efficacy for adjuvant and metastatic settings, respectively.Analysis of the DCE data using Hierarchical Bayesian (HB) model revealed distinct preferences among the 104 survey respondents.Efficacy, as assessed by 4-year RFS in the adjuvant setting and 4-year OS in the metastatic setting, was the most important attribute, followed by severe adverse events (AEs) and dosing regimen.Immune checkpoint inhibitors (ICI) were consistently ranked as the preferred options across all patient segments. Based on the hypothetical drug profile presented in the DCE, the fixed dose combination of nivolumab and relatlimab was the preferred regimen in the metastatic disease setting while either pembrolizumab or nivolumab were preferred in the adjuvant setting.Our study highlights the importance of considering patients' prioritization of treatment efficacy as the primary factor when making decisions about melanoma care, both in the adjuvant and metastatic settings. Although efficacy and safety were attributed to have relatively similar importance for treatment preference in the adjuvant setting, patients with more advanced disease or those carrying the BRAF mutation placed heightened emphasis on treatment efficacy.