OBJECTIVES: We aimed to understand the preferences of oncologists and patients regarding key attributes associated with anaplastic lymphoma kinase (ALK) tyrosine kinase inhibitors (TKIs) in the first line (1L) setting, and their willingness to trade-off between benefits and risks.

METHODS: Thirty hybrid semi-structured interviews were conducted among 10 oncologists and 20 ALK+ advanced non-small cell lung cancer (aNSCLC) patients in the US. Both qualitative and quantitative methods were applied: interview data were analyzed using an inductive thematic approach, while quantitative responses were analyzed descriptively.

RESULTS: The mean age of patients was 52 years (range 38-69); 20% were non-white, and 60% had brain metastases. The majority of oncologists (80%) practiced in community settings.

The top treatment benefits desired by patients and oncologists were improving overall survival (90%, 100% respectively), progression free survival (85%, 70%) and preventing metastases (65%, 60%). Quality of life was perceived through cancer control. Patients reported highest experience with treatment-caused fatigue (85%), weight gain (65%), and muscle pain (65%), while oncologists reported patients mostly experienced fatigue (80%), nausea (60%), and cognitive effects (50%).

Both oncologists and patients were most concerned about fatigue (50% and 30%) and cognitive effects (40% and 50%). Patients were more concerned than oncologists about weight gain (35% vs 10%), and hyperlipidemia (35% vs 10%); whereas oncologists were more concerned than patients about ocular toxicity (30% vs 5%). Patients were apprehensive about treatment-related AEs leading to dose reduction or discontinuation. However, they were willing to tolerate AEs in exchange for efficacy.

CONCLUSIONS: Understanding the trade-offs that oncologists and patients are willing to make between key attributes influencing treatment choice helps facilitate shared decision making with 1L ALK+ TKI treatments. Findings from this qualitative study will inform a follow-up study to quantify tradeoffs among 1L ALK TKIs.