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Patient preferences for maintenance PARP inhibitor therapy in ovarian cancer treatment

  • Laura J. Havrilesky
    Correspondence
    Corresponding author at: Box 3079, DUMC, Durham, NC 27710, United States of America.
    Affiliations
    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
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  • Stephanie Lim
    Affiliations
    Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, United States of America
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  • Jessie A. Ehrisman
    Affiliations
    Division of Gynecologic Oncology, Duke University Medical Center, Durham, NC, United States of America
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  • Amelia Lorenzo
    Affiliations
    Division of Gynecologic Oncology, Duke University Medical Center, Durham, NC, United States of America
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  • Angeles Alvarez Secord
    Affiliations
    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
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  • Jui-Chen Yang
    Affiliations
    Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, United States of America
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  • F. Reed Johnson
    Affiliations
    Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, United States of America

    Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States of America
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  • Juan Marcos Gonzalez
    Affiliations
    Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, United States of America

    Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States of America
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  • Shelby D. Reed
    Affiliations
    Duke Cancer Institute, Duke University Medical Center, Durham, NC, United States of America

    Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, United States of America

    Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States of America
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Published:January 22, 2020DOI:https://doi.org/10.1016/j.ygyno.2020.01.026

      Highlights

      • A survey was conducted to elicit the preferences of women with ovarian cancer for risks and benefits of PARP inhibitors.
      • Overall survival benefit and anticipated out of pocket costs most highly influenced women's choices.
      • Women expected at least 3–4 months of PFS in exchange for minimal side effects from taking a PARP inhibitor.

      Abstract

      Objective

      To measure preferences of women with ovarian cancer regarding risks, side effects, costs and benefits afforded by maintenance therapy (MT) with a poly ADP ribose polymerase (PARP) inhibitor.

      Methods

      A discrete-choice experiment elicited preferences of women with ovarian cancer regarding 6 attributes (levels in parentheses) relevant to decisions for MT versus treatment break: (1) overall survival (OS; 36, 38, 42 months); (2) progression-free survival (PFS; 15, 17, 21 months); (3) nausea (none, mild, moderate); (4) fatigue (none, mild, moderate); (5) probability of death from myelodysplastic syndrome/acute myelogenous leukemia (MDS/AML; 0% to 10%); (6) monthly out-of-pocket cost ($0 to $1000). Participants chose between 2 variable MT scenarios and a static scenario representing treatment break, with multiple iterations. Random-parameters logit regression was applied to model choices as a function of attribute levels.

      Results

      95 eligible participants completed the survey; mean age was 62, 48% had recurrence, and 17% were ever-PARP inhibitor users. Participants valued OS (average importance weight 24.5 out of 100) and monthly costs (24.6) most highly, followed by risk of death from MDS/AML (17.9), nausea (14.7), PFS (10.5) and fatigue (7.8). Participants would accept 5% risk of MDS/AML if treatment provided 2.2 months additional OS or 4.8 months PFS. Participants would require gains of 2.6 months PFS to accept mild treatment-related fatigue and 4.4 months to accept mild nausea.

      Conclusions

      When considering MT, women with ovarian cancer are most motivated by gains in OS. Women expect at least 3–4 months of PFS benefit to bear mild side effects of treatment.

      Keywords

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