Physician Treatment of Metastatic Triple-Negative Breast Cancer in the Immuno-Oncology Era: a Discrete Choice Experiment

Abstract

Aim: Guidelines list atezolizumab with nab-paclitaxel (ANP) as the preferred first-line (1L) therapy for metastatic triple-negative breast cancer (mTNBC) with PD-L1 expression ≥1%, but which clinical attributes impact ANP prescribing? Materials & methods: Medical oncologists participated in a discrete choice experiment (DCE) with four hypothetical mTNBC clinical scenarios to assess influences of: PD-L1 expression, menopausal status, prior adjuvant therapy and bulky liver metastases. Results: A total of 47% chose ANP in 1L irrespective of menopausal status, prior adjuvant therapy or tumor bulk. PD-L1 expression was the only attribute with a significant impact on ANP preference, with 69% choosing ANP for those with ≥1% expression versus only 26% for those with <1% (p < 0.00001). Conclusion: ANP choice for 1L mTNBC deviated from guidelines.

Lay abstract

Aim: Doctors aspire to practice evidence-based medicine, but the complexities of modern healthcare in which conflicting evidence, patient preferences, payer benefit design, financial toxicity and social determinants of health often challenge that pursuit. This is particularly true in the treatment of metastatic breast cancer (mBC). Materials & methods: To better understand the influence of treatment of triple-negative mBC, we designed a discrete choice experiment to examine the influence of patient age, disease severity, prior treatment and biomarkers on the choice for the recently approved novel treatment, atezolizumab with nab-paclitaxel (ANP), on triple-negative mBC. Results: ANP choice was relatively high, but unlike the traditional choices of single agent or combination chemotherapy which were influenced by age, disease severity and prior treatment, ANP choice was only influenced by biomarkers. Conclusion: ANP appears to have been rapidly adopted and is the preferred treatment across varied disease presentations. Biomarker influence on its choice is noteworthy but inconsistent across our survey sample.

Keywords::

• clinical attributes
• discrete choice experiment
• mTNBC

Financial & competing interests disclosure

This study was funded by Athenex, Inc., Buffalo, NY, USA. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Ethical conduct of research

On 29 January 2020, Western Institutional Review Board (WIRB) approved a request for a waiver of authorization for use and disclosure of protected health information (PHI) for this research.

Data sharing statement

Datasets generated during and/or analyzed during the current study will not be deposited.

Additional information

Funding

This study was funded by Athenex, Inc., Buffalo, NY, USA. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.