Havrilesky Laura J, Scott Amelia L, Davidson Brittany A, Secord Angeles Alvarez, Yang Jui-Chen, Johnson F Reed, Gonzalez Juan Marcos, Reed Shelby D
Division of Gynecologic Oncology, Duke University Medical Center, Durham, NC, United States of America; Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, United States of America; Duke Cancer Institute, Duke University Medical Center, Durham, NC, United States of America.
Division of Gynecologic Oncology, Duke University Medical Center, Durham, NC, United States of America.
Gynecol Oncol. 2021 Aug;162(2):440-446. doi: 10.1016/j.ygyno.2021.05.022. Epub 2021 May 28.
To assess preferences of women with ovarian cancer regarding features of available anti-cancer regimens for platinum-resistant, biomarker-positive disease, with an emphasis on oral PARP inhibitor and standard intravenous (IV) chemotherapy regimens.
A discrete-choice-experiment preferences survey was designed, tested, and administered to women with ovarian cancer, with 11 pairs of treatment profiles defined using seven attributes (levels/ranges): regimen (oral daily, IV weekly, IV monthly); probability of progression-free (PFS) at 6 months (40%-60%); probability of PFS at 2 years (10%-20%); nausea (none, moderate); peripheral neuropathy (none, mild, moderate); memory problems (none, mild); and total out-of-pocket cost ($0 to $10,000).
Of 123 participants, 38% had experienced recurrence, 25% were currently receiving chemotherapy, and 18% were currently taking a PARP inhibitor. Given attributes and levels, the relative importance weights (sum 100) were: 2-year PFS, 28; cost, 27; 6-month PFS, 19; neuropathy,14; memory problems, nausea, and regimen, all ≤5. To accept moderate neuropathy, participants required a 49% (versus 40%) chance of PFS at 6 months or 14% (versus 10%) chance at 2 years. Given a 3-way choice where PFS and cost were equal, 49% preferred a monthly IV regimen causing mild memory problems, 47% preferred an oral regimen causing moderate nausea, and 4% preferred a weekly IV regimen causing mild memory and mild neuropathy.
These findings challenge the assumption that oral anti-cancer therapies are universally preferred by patients and demonstrate that there is no "one size fits all" regimen that is preferable to women with ovarian cancer when considering recurrence treatment regimens.
评估卵巢癌女性患者对于铂耐药、生物标志物阳性疾病现有抗癌方案特征的偏好，重点关注口服聚（腺苷酸-核糖）聚合酶（PARP）抑制剂和标准静脉化疗方案。
设计、测试并对卵巢癌女性患者进行了一项离散选择实验偏好调查，使用七个属性（水平/范围）定义了11对治疗方案：方案（每日口服、每周静脉注射、每月静脉注射）；6个月无进展生存期（PFS）概率（40%-60%）；2年PFS概率（10%-20%）；恶心（无、中度）；周围神经病变（无、轻度、中度）；记忆问题（无、轻度）；以及自付费用总额（0美元至10,000美元）。
123名参与者中，38%经历过复发，25%目前正在接受化疗，18%目前正在服用PARP抑制剂。给定属性和水平，相对重要性权重（总和为100）为：2年PFS，28；费用，27；6个月PFS，19；神经病变，14；记忆问题、恶心和方案，均≤5。为了接受中度神经病变，参与者需要6个月时PFS概率为49%（而非40%）或2年时为14%（而非10%）。在PFS和费用相等的三选一选择中，49%的人更喜欢导致轻度记忆问题的每月静脉注射方案，47%的人更喜欢导致中度恶心的口服方案，4%的人更喜欢导致轻度记忆问题和轻度神经病变的每周静脉注射方案。
这些发现挑战了口服抗癌疗法普遍受患者青睐的假设，并表明在考虑复发治疗方案时，不存在对卵巢癌女性患者普遍适用的“一刀切”方案。
