There is limited understanding of the attributes of adjuvant systemic therapy that are preferred by patients and physicians in the management of early-stage genitourinary (GU) cancers in Asia-Pacific, particularly renal cell carcinoma (RCC) and urothelial carcinoma (UC).

This multi-territory, cross-sectional study was conducted using a discrete-choice experiment (October 2024-January 2025) to assess the treatment preferences of physicians (medical oncologists and urologists) and GU cancer patients (aged ≥18 years; RCC: n=50, UC: n=50) in Australia, Hong Kong, Singapore, Malaysia, and Taiwan. Relative preference weights, relative importance (RI) of each attribute and the minimum acceptable benefit for maximum acceptable risk were analysed using hierarchical Bayesian logistic regression. The DCE survey included 8 attributes spanning efficacy, risk of select treatment-related adverse events (AEs) and mode of administration. The preferred timing for using a hypothetical treatment approved for use in both early and late-stage GU cancers was also assessed.

Amongst physicians, 46 medical oncologists and 44 urologists were included. A total of 50 RCC, 35 non-muscle invasive bladder cancer (NMIBC) and 15 muscle-invasive bladder cancer (MIBC) patient respondents were included, with the majority of RCC patients categorized as Stage 2. Physicians regarded “Probability of disease-free survival (DFS) in 1-year” (RI=36.3%) as the most important treatment attribute when choosing early-stage cancer treatments, followed by “Overall survival (OS)” (RI=22.1%) and “Risk of treatment-related skin rash” (RI=8.5%). Patients placed similar importance to “OS” (RI=27.6%) and “Probability of DFS in 1-year” (RI=25.1%), followed by “Risk of treatment-related fatigue” (RI=9.9%). Physicians were most willing to accept increase in risks (from 5% to 35%) of treatment-related skin rash for 8.0% DFS /0.74-year OS increase and fatigue for 6.1% DFS /0.56-year OS increase. Patients were willing to accept a higher likelihood (from 5% to 35%) of treatment-related fatigue for 11.4% DFS /0.67-year OS increase, and long-term/permanent adverse events (AEs) (from 1% to 15%) for 10.8% DFS/0.64-year OS increase. Most physicians (88-96%) and patients (87-92%) prefer starting systemic treatment early in the disease course, rather than reserve the treatment for an advanced stage.

Physicians and patients valued efficacy attributes for early-stage RCC and UC treatment over AE-associated attributes. Physicians placed more importance on DFS than OS, while patients placed similar importance to DFS and OS. Both were willing to make trade-offs by accepting greater risk of AEs for higher efficacy benefits, though these trade-offs varied depending on type of AE. This indicates a need for shared decision-making amongst physicians and patients in Asia-Pacific for early-stage GU cancers.