Patient and caregiver preferences for the treatment of locally advanced or metastatic urothelial carcinoma (la/mUC): Results of a targeted literature review (TLR).

755 Background: The treatment landscape for la/mUC has evolved with multiple care options available. As new therapies are adopted, decision-making among physicians, patients, and their caregivers becomes more complex and challenging. This study summarizes the existing literature on preferences of patients and caregivers about aspects of treatment following a diagnosis of la/mUC. Methods: A TLR of English-language conference abstracts and full-text manuscripts published from 2015 was conducted using Embase and PubMed, to identify qualitative and quantitative studies on the treatment preferences of patients with la/mUC and caregivers of people with la/mUC. Literature was independently screened against predefined eligibility criteria by two researchers, with a third researcher resolving disagreements. Results: Data from 13 publications were extracted (n=10 77% qualitative, n=3 23% quantitative); of these, 6 (46%) were full-text manuscripts and 7 (54%) were conference abstracts/posters. When specified, most studies (6/10 60%) were conducted in the US. Six studies (46%) assessed preferences among both patients and caregivers. The quantitative preference studies assessed varied efficacy endpoints, including overall survival (n=2), overall response rate (ORR; n=1), and progression-free survival (n=1). Treatment efficacy was the most important consideration in 2 quantitative studies, while 1 study found adverse events (AEs), combined with number and duration of medicines, to be more important to patients. Across publications, attributes related to treatment AEs significantly impacted preferences. Unmet needs related to symptoms and AEs were identified. The symptoms/AEs reported most frequently across all 13 studies were fatigue (n=7 53%), cancer-related pain (n=6 46%), peripheral neuropathy (PN; n=3 23%), blood in urine (n=3 23%), and nausea (n=3 23%). In 1 quantitative study, cancer-related pain was ranked as the second most important treatment attribute after ORR. Patients in this study also indicated that they would accept a 7.8% reduction in ORR to reduce the risk of developing PN by 10%. Of 3 studies that compared differences between patient and caregiver preferences, 2 quantitative studies found that caregivers placed a higher importance on avoiding side effects than patients. Conclusions: Despite heterogeneity in study designs and outcomes reported, patients and caregivers often prioritized treatment efficacy over tolerability. However, in quantitative studies, patients and caregivers were willing to accept lower efficacy for a more tolerable treatment, although the magnitude of trade-offs varied by AE. Such insights highlight the importance of incorporating patient and caregiver preferences in shared decision-making and personalizing treatment according to individual patient goals.