Physician Preferences in mCRC Treatment: Balancing Survival and Toxicity

A recent survey conducted among physicians in the United Kingdom (UK) and Germany reveals critical insights into the decision-making processes regarding third-line treatment options for metastatic colorectal cancer (mCRC). The findings, presented at the 2025 European Society for Medical Oncology (ESMO) Gastrointestinal Cancer Congress, indicate that overall survival (OS) improvements are paramount for physicians when considering the acceptance of increased toxicity and treatment burden associated with third-line regimens.
The study, which surveyed 156 oncologists and gastroenterologists from both countries, highlighted that while physicians prioritize OS and progression-free survival (PFS), they are also inclined to accept a lower OS if it means reducing treatment-related toxicities and burdens. Specifically, physicians required a minimum increase in OS—1.1 months for German physicians and 1.3 months for their UK counterparts—to accept a 10% increase in the risk of grade 3 or higher neutropenia or hand-foot syndrome.
Ashley Geiger, PhD, Associate Director of Oncology Patient-Centered Outcomes at Takeda and lead author of the survey, emphasized that the results underscore the necessity for new treatments to align with physician preferences to enhance clinical decision-making and ensure real-world applicability. "These findings indicate that physicians require survival gains to accept increased toxicity or more burdensome treatment regimens, such as those requiring IV administration," Geiger stated during the presentation.
The survey results showed a consensus among physicians regarding the significance of various treatment attributes. In Germany, OS was rated as the most critical attribute (1.8), followed closely by the 3-month PFS rate (3.1), and the risk of grade 3 or higher neutropenia (3.7). UK physicians rated OS similarly at 2.0, with the 3-month PFS rate and neutropenia risk following closely behind.
Physicians reported a high level of comfort managing common toxicities associated with mCRC treatments, with 91.4% of German physicians and 78.7% of UK physicians feeling somewhat or very comfortable managing grade 3 or higher neutropenia. Conversely, only about half expressed similar comfort levels for managing grade 3 or higher hand-foot syndrome and any-grade fatigue.
The survey methodology involved a detailed assessment of treatment attributes, which were established through a comprehensive literature review, clinical data analysis, and interviews with both patients and physicians. Participants ranked eight identified attributes from most to least important and engaged in paired comparison tasks to delineate their treatment preferences.
This study sheds light on the evolving landscape of mCRC treatment options, which often provide modest OS improvements of 2 to 3 months but come with varying toxicity profiles. It highlights the challenges physicians face in balancing these survival gains with the associated risks and quality of life considerations.
Future research should delve into how these treatment attributes influence patient preferences, aiming to create a more holistic view of treatment decision-making in mCRC. The findings not only impact clinical practice but also inform pharmaceutical development, ensuring that new therapies meet the needs and expectations of healthcare providers.
In conclusion, understanding physician preferences in the context of mCRC treatment is critical for aligning clinical decision-making with patient care. As the landscape of cancer treatment continues to evolve, the integration of physician insights into treatment development will be essential for optimizing outcomes in metastatic colorectal cancer.
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