Lung cancer, CT
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A survey of people in the U.S. at high risk for lung cancer has shown that most would be willing to accept risks associated with lung cancer interception therapy—such as serious infection—if it meant their lung cancer risk was reduced.

There are currently no approved treatments that actively interrupt the process of lung cancer development before it is detectable on computed tomography (CT) imaging or becomes symptomatic, but cancer researchers are exploring the possibility that the anti-inflammatory pathway could be a target for lung cancer interception therapy.

However, “[i]nterception therapy is associated with uncertain treatment benefit, as a person may never develop lung cancer even if not taking the interception therapy or may still develop lung cancer despite taking the interception therapy,” writes Ellen Janssen, from Janssen Research and Development, and colleagues in JAMA Network Open.

They therefore set out to estimate the willingness of individuals at risk of lung cancer to accept the risks of experiencing up-front adverse events in exchange for uncertain future treatment benefit.

In total, 803 people (62% women) eligible for lung cancer screening according to U.S. Preventive Services Task Force guidelines completed an online “discrete-choice experiment” survey. They were asked to state their preferred choice between competing scenarios, which allows the researchers to explore tradeoffs that participants were willing to make across treatment benefits and risks. These included reduction in lung cancer risk over three years, injection site reaction severity, nonfatal serious infection, and death from serious infection.

All participants were aged 50 to 80 years (mean 63 years), were U.S. residents, currently smoked or had quit smoking within the past 15 years, had at least a 20 pack–year smoking history, and did not have a history of lung cancer, dementia, mild cognitive impairment, or schizophrenia. They were assigned to a theoretical baseline lung cancer risk of 6%, 10%, or 16% over three years.

The researchers report that reducing lung cancer risk was the most important attribute when considering interception therapy. When they looked at maximum acceptable risks, they found that respondents were willing to accept a 25.8 percentage point increase in the risk for nonfatal serious infection and a 1.7 percentage point increase in the risk for death if their 3-year risk for lung cancer was reduced from 60% to 30%.

“Participants were therefore willing to consider treatments with serious potential risk if it provided a chance of reducing their risk of developing lung cancer,” the research team told Inside Precision Medicine in an email interview.

The authors also looked at minimum acceptable benefits and found that respondents would require at least a 15.4 percentage point decrease in lung cancer risk to accept a 12.0 percentage point increase in risk of nonfatal serious infection, and at least a 23.1 percentage point decrease in lung cancer risk to accept a 1.2 percentage point increase in risk of death from serious infection.

There were no statistically significant differences in preferences related to severity levels of injection site reaction, “indicating that respondents did not place much importance on this when making decisions considering the other attributes,” Janssen et al remark. They also note that baseline lung cancer risk was not associated with treatment preference but acknowledge that the range of baseline risks (6% to 16%) may have been too small to influence this.

Just 16.1% of respondents were unwilling to accept interception therapy in any scenario. These participants were more likely to be older and to currently smoke with no prior cessation attempt than those willing to accept therapy and were less likely to have been vaccinated against COVID-19 or examined for skin cancer.

The investigators will continue to evaluate the benefit-risk tradeoffs that patients are willing to make when making hypothetical treatment decisions, not only in the lung cancer interception area but also in other therapeutic areas. The group says: “Such patient preference studies are critical as they put patients at the center and provide quantification of the balance of benefits and risks of new treatments from a patient perspective. It ensures that patients’ preferences and experiences can be considered in the medical decision-making process.”

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