In the rapidly evolving landscape of metastatic breast cancer treatment, understanding patient preferences has emerged as a critical component for optimizing therapeutic strategies. A groundbreaking study conducted in Italy has shed new light on how patients with hormone receptor-positive (HR+) and human epidermal growth factor receptor 2-negative (HER2−) metastatic breast cancer weigh the benefits and risks of various treatment options. Published recently in the prestigious journal BMC Cancer, this research utilized a discrete choice experiment (DCE) to capture the nuanced valuations patients assign to treatment efficacy and side effect profiles, signaling a fresh paradigm that integrates patient voices into clinical decision-making.
Hormone receptor-positive and HER2-negative breast cancer remains the most frequently diagnosed subtype worldwide. Despite advances in early detection and localized treatments, Stage IV metastatic disease presents significant challenges both clinically and emotionally. Treatment regimens have expanded considerably, encompassing next-generation endocrine therapies such as selective estrogen receptor degraders (SERDs), third-generation aromatase inhibitors (AIs), and a variety of targeted agents inhibiting key pathways like CDK4/6, PI3K, and mTOR. Furthermore, antibody-drug conjugates (ADCs) such as trastuzumab deruxtecan (T-DXd) and sacituzumab govitecan (SG) have introduced novel mechanisms of action that improve survival outcomes. However, with an increasing arsenal of therapies, doctors and patients alike face complex decisions balancing efficacy with safety and quality of life.
The innovative study spearheaded by Arpino, De Angelis, Gerratana, and colleagues addressed this complexity by engaging 102 Italian patients diagnosed with Stage IV HR+ HER2− metastatic breast cancer. Participants were presented with a series of hypothetical treatment choices characterized by differing attributes such as progression-free survival (PFS) benefits and the likelihood of severe side effects, particularly grade 3 or higher adverse events (AEs). Employing a discrete choice experiment methodology enabled the researchers to quantify the relative importance patients assign to these attributes, capturing trade-offs that are otherwise difficult to measure.
Key findings from the study reveal a clear prioritization of treatment efficacy among patients. Progression-free survival emerged as the most valued attribute, indicating that patients strongly desire therapies that can extend the period during which their disease does not worsen. This preference underscores the hope patients place on durable disease control, which not only translates into longer life expectancy but also the opportunity to maintain better health and daily functioning for longer intervals. Importantly, this preference remained consistent across diverse patient subgroups, emphasizing its universal relevance in metastatic breast cancer care.
Equally noteworthy was the ranking of safety considerations. The risk of experiencing grade 3 or higher adverse events was identified as the second most crucial treatment characteristic. Severe side effects, which can range from significant fatigue and infections to more debilitating toxicities, substantially impact patients’ quality of life and willingness to adhere to prescribed regimens. This finding highlights the intricate balance patients seek: maximizing therapeutic benefit while minimizing harmful sequelae. It offers a vital insight for clinicians and drug developers as they strive to tailor treatments that align with patient priorities.
The Italian study further underscored how differential side effect profiles underpin treatment preferences. For instance, therapies with a favorable tolerability profile, reducing the incidence of severe AEs, significantly swayed patient choices even when efficacy gains were comparable. Such nuances indicate that patient-centered care must move beyond efficacy metrics alone and incorporate comprehensive evaluation of adverse event burdens. This approach may foster better acceptance and satisfaction with chosen therapies, potentially enhancing overall healthcare outcomes.
Notably, the application of discrete choice experiments deepens our understanding of patient decision-making in oncology, a field traditionally dominated by physician-led treatment algorithms. This quantitative approach simulates real-life trade-offs by forcing respondents to elect between competing interventions with variable attributes, presenting a more realistic appraisal of how patients may behave when confronted with actual therapeutic options. The strength of this methodology lies in its ability to capture nuanced preferences that can guide shared decision-making processes and inform regulatory and reimbursement policies.
This research also signals a shift toward personalized medicine encompassing patient preference integration, an aspect often overlooked in clinical trials that primarily focus on survival endpoints and toxicity incidence. By incorporating patient valuations of treatment attributes, healthcare providers may better align therapy choices with individual patient values, promoting adherence and satisfaction. The findings highlight that patients are not passive recipients but active partners in their care, bringing unique perspectives that can transform healthcare delivery.
Furthermore, the researchers emphasized that understanding preference heterogeneity is essential as patient situations evolve. Factors such as previous treatments, comorbidities, age, and social support networks can modulate how patients evaluate treatment options. While efficacy generally dominates preferences, some patient segments may weigh adverse events or mode of administration more heavily, suggesting the need for flexible, context-sensitive decision frameworks. These insights advocate for routine incorporation of structured preference assessments in clinical consultations.
Beyond clinical care, these findings resonate with drug development pipelines and health technology assessments. Pharmaceutical companies can leverage patient preference data to prioritize development of compounds with balanced efficacy and safety profiles that resonate with patient needs. Regulators and payers might also consider such data in evaluating the value and reimbursement of novel agents, potentially accelerating access to treatments that patients genuinely favor.
This seminal work from Italy highlights an emerging trend where patient-centered outcomes research intersects with pharmacology, oncology, and health economics. By quantifying what matters most to patients living with challenging metastatic breast cancer, the study empowers physicians and stakeholders to make informed, empathetic choices that transcend traditional clinical metrics. It represents an important step toward harmonizing medical innovation with lived patient experience.
As metastatic HR+ HER2− breast cancer continues to challenge researchers and clinicians globally, integrating patient preferences into therapeutic decision-making may improve survival outcomes and quality of life alike. Future research expanding on these findings could explore longitudinal changes in preferences as treatments advance and disease trajectories evolve. Additionally, cross-cultural studies might reveal geographic variations that inform localized strategies for patient engagement.
In conclusion, this discrete choice experiment conducted among Italian patients unveils that treatment efficacy, particularly progression-free survival, remains the foremost priority for Stage IV HR+ HER2− metastatic breast cancer patients. Close behind is the imperative of minimizing severe adverse events, reinforcing the delicate balance patients seek in treatment decisions. Through methodical and patient-focused inquiry, this study illuminates the path toward more personalized, value-driven oncology care where patient voices steer therapeutic journeys.
Such insights affirm that the future of metastatic breast cancer treatment lies not only in scientific advances but equally in embracing the patient experience. Aligning clinical excellence with patient preferences promises to elevate care standards and transform outcomes in this complex disease setting.
Subject of Research: Patient treatment preferences in hormone receptor-positive/HER2-negative metastatic breast cancer
Article Title: Patient preferences for treatments in hormone receptor-positive/HER2-negative metastatic breast cancer in Italy: a discrete choice experiment study
Article References:
Arpino, G., De Angelis, C., Gerratana, L. et al. Patient preferences for treatments in hormone receptor-positive/HER2-negative metastatic breast cancer in Italy: a discrete choice experiment study. BMC Cancer 25, 920 (2025). https://doi.org/10.1186/s12885-025-14308-4
Image Credits: Scienmag.com
