Study Reveals Key Factors Guiding Shared Decision-Making for BRAF V600E/K+ Melanoma

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Oncologists take multiple treatment attributes into consideration when deciding between options for patients with BRAF V600E/K-mutant metastatic melanoma. According to research presented in a poster during the International Society for Pharmacoeconomics and Outcomes (iSPOR) 2023 Meeting, progression-free survival (PFS) and safety are the key drivers of treatment choice.¹

Currently, 3 BRAF/MEK combinations are FDA-approved for the treatment of BRAF/MEK-mutant metastatic melanoma. The combinations include dabrafenib (Tafinlar) plus trametinib (Mekinist), vemurafenib (Zelboraf) plus cobimetinib (Cotellic), and encorafenib (Braftovi) plus binimetinib (Mektovi). Although these mechanisms are similar, they differ in terms of the ways they are dosed, their safety profiles, and their efficacy.

The study observed treatment decisions made by patients based on information given by their providers regarding available therapies. Patients were asked to decide on several attributes that weigh on their decision making. The attributes included efficacy, safety (fever, diarrhea, photosensitivity), dosing scheduling, and food requirement.

With a mean preference weight of 2.83 (range, -2.73 to 5.56), efficacy (PFS) was the most important factor guiding treatment choice. Among the safety attributes observed, the potential for fever carried the most weight among patients, with a mean weight of 2.11 (range, -2.47 to 4.58). Few patients had a preference regarding the food requirement attribute, and the mean weight in this category was 0.72 (range, -0.72 to 1.44).

Investigators evaluated the first 12 patients using a review of existing peer-reviewed literature, which included patient-focused qualitative research and the labels of FDA-approved BRAF/MEK inhibitors. Investigators then gathered direct feedback from the patients with BRAF V600E/K-mutant metastatic melanoma through qualitative interviews. Attributes and levels were chosen based on patient perception and clinical evidence supporting the therapies.

During the second phase, investigators recruited patients to participate in a cross-sectional online survey, which included the discrete choice experiment. The patients chose and completed 12 tasks for the discrete choice experiment and selected their preferred treatment.

The patient population was made up of those with a median age of 49 years (range, 22-74). Males made up 21.9% of the population, and females made up the remaining 78.2%. In terms of ethnic origin, Caucasian patients made up 97.2% of the population. The other patients were Hispanic or Latino (1.4%), Black/African American (0.7%), and Native American or American Indian (0.7%). For geographic location, there were patients from across the United States (US).

Most patients had adequate literacy and were employed. The majority of patients noted that they were capable of tanning, per the Fitzpatrick scale adaptation. It had been roughly a year for most patients since being diagnosed with melanoma. About 57% of patients were BRAF-mutation positive, 34.5% were BRAF-negative, and the BRAF mutational status was unknown for 8.2%. Most patients had stage IV melanoma (58.5%), and 39.4% had stage III disease. The stage of disease was unknown for 2.1% of the population. Overall, 73.2% of the population had never received BRAF/MEK inhibitor therapy.

Overall, 27.2% of patients responded stating that efficacy was an important attribute, and 21.5% considered fever to be an important attribute. Diarrhea had a relative attribute importance (RAI) rate of 19.3%. The RAI for phonocentricity, dosing scheduling, and food requirements were 12.8%, 11.4%, and 7.9%, respectively. Looking at attributes and levels, the investigators noted that patients prefered the profile of encorafenib and binimetinib over other regimens.

The study underscores the relevance of the individualized approach for administering BRAF/MEK therapy in the US and highlights the value of shared decision-making between oncologists and their patients.

_REFERENCE:

_{Mason B, Mesana L, Hallworth P, et al. Quantifying patient preferences for targeted therapies in metastatic melanoma: a discrete-choice experiment. Presented at: 2023 International Society for Pharmacoeconomics and Outcomes Research; May 7-10, 2023. Boston, MA.}