Lung cancer

Lung cancer is the most common malignancy in men and the third most common in women. The most frequent symptoms that patients report upon disease presentation are cough, dyspnea, chest pain, fatigue, chest infection, hemoptysis, and weight loss, all of which greatly overlap with symptoms of other common chronic respiratory conditions and are often only present at later stages of the disease.


The overlap is one cause of the delay between presentation and diagnosis, which means that lung cancer is diagnosed in late stages in half of all cases. The prevalence of late-stage diagnosis is one of the reasons why lung cancer has such a low survival rate: a 5-year overall survival rate of 18.1% in all lung cancer stages and 4.5% in the metastatic stage.

In recent years, we have witnessed a shift in the treatment paradigm of Non-Small Cell Lung Cancer (NSCLC). Specifically, the inclusion of a new pharmacological approach with the inclusion of Immuno-checkpoint inhibitor therapies that focus on the regulation of the immune system to attack the cancer instead of attacking it directly as chemotherapy does. The approval of the combination of chemo and immunotherapy as first line treatment for advanced NSCLC, while providing a clear benefit for NSCLC patients who are not eligible for mono-immunotherapy treatments (with PD-L1 low/negative), poses a new alternative of care for those patients who can now choose between an immunotherapy treatment, plus a chemotherapy treatment in a subsequent line of treatment, and combined chemo-immunotherapy treatment, that has an increased chance of adverse events and more critical side effects, but can be more effective against more aggressive cancers.

Since a direct comparison between the two has not been able to provide evidence of which choice is to be preferred, patient preferences are crucial when choosing between a more “aggressive” approach with a higher toxicity profile or a less intense alternative. PREFER has the objective to identify and evaluate which elements are relevant for patients and should be considered when evaluating the treatment. The study will include NSCLC patients from Italy and Belgium in a different stage to define how preferences evolve according to different stages of the disease. The study will adopt different methods to assess patients’ preferences to evaluate the similarity of the results.


Monzani, Dario; Petrocchi, Serena; Oliveri, Serena; Veldwijk, Jorien et al. Patient Preferences for Lung Cancer Treatments: A Study Protocol for a Preference Survey Using Discrete Choice Experiment and Swing Weighting, Frontiers in Medicine, Vol. 8, article id 689114

Janssens R, Arnou R, Schoefs E et al, Key Determinants of Health-Related Quality of Life Among Advanced Lung Cancer Patients: A Qualitative Study in Belgium and Italy, Frontiers in Pharmacology, 23 September 2021

Petrocchi S, Janssens R, Oliveri S, Arnou R et al. What Matters Most to Lung Cancer Patients? A Qualitative Study in Italy and Belgium to Investigate Patient Preferences, Frontiers in Pharmacology, 4 March 2021

Durosini I, Janssens R, Arnou R, Veldwijk J et al. Patient Preferences for Lung Cancer Treatment: A Qualitative Study Protocol Among Advanced Lung Cancer Patients, Frontiers in Public Health, Frontiers in Public Health, 5 February 2021


Therapeutic area: Lung cancer

Study led by: European Institute of Oncology

PREFER leads team: Gabriella Pravettoni, Serena Oliveri (from January 2020), Meredith Smith

MPLC decision points of interest: Post marketing authorisation

PREFER case study acronym: Lung Cancer

Clinical objectives: Identify and quantify patient-relevant benefit-risk attributes of LC treatments, Quantify the risk tolerance for experiencing adverse events (Maximum Acceptable Risk) that patients are willing to accept for an increased probability of prolonged survival

Patients from: Italy, Belgium

Methods in Qualitative study: Focus Group Discussion with Thematic Analysis
Nominal Group Technique

Methods in Quantitative study: Discrete Choice Experiment (DCE)

End-date qualitative data collection: October 2019

End-date quantitative data collection: Q3/Q4 2020


Non-Small Cell Lung Cancer is sometimes called non-small cell lung carcinoma, or NSCLC for short) is the most common form of lung cancer and among the deadliest. It represents approximately 85% of all types of lung cancer worldwide and only 21.7% of patients diagnosed with this type of cancer are alive five years after being diagnosed. In order to help patients, different types of treatments are available for this condition. Traditional medical treatments for advanced stages of non-small cell lung cancer include chemotherapy and/or targeted radiotherapy. Now, there is a promising new type of treatment called immunotherapy.

We wanted to learn about lung cancer patients’preferences for new treaments, and what they considered to be the maximum acceptable risk, and the minimum acceptable benefit of a treatment.

Non-small cell lung cancer

Smith M, Oliveri S & Casiraghi M, Treating non-small cell lung cancer: What do patients PREFER?, Zenodo, DOI: 10.5281/zenodo.6260511






  • Disclaimer: This website and its contents reflects the PREFER project's view and not the view of IMI, the European Union or EFPIA.


The Patient Preferences in Benefit-Risk Assessments during the Drug Life Cycle (PREFER) project has received funding from the Innovative Medicines Initiative 2 Joint Undertaking under grant agreement No 115966. This Joint Undertaking receives support from the European Union's Horizon 2020 research and innovation programme and the European Federation of Pharmaceutical Industries and Associations (EFPIA).