There are more systemic therapies in the adjuvant setting available to lower the chance of recurrence in patients with operable high-risk melanoma. However, risk of toxicities may contribute to lower than expected uptake. This study assessed the risk tolerance for pyrexia of patients with advanced melanoma in the adjuvant setting using the threshold technique (TT), a survey-based patient-preference method administered online to a sample of 50 adults with self-reported stage III melanoma in the US. Respondents evaluated two adjuvant treatment options—a reference treatment representing the standard of care with a 44% chance of recurrence after 1 year of systemic therapy and no treatment-related risk of pyrexia and an alternative treatment with a 63% risk of pyrexia (described as fever of 100-104+ that might recur). In the first series of TT questions, the alternative treatment had unknown efficacy, representing the context of a clinical trial. In a second series of TT questions, respondents were told the chance of recurrence for the alternative treatment was 12% after 1 year. The risk of pyrexia for the alternative treatment was varied systematically to define the range of pyrexia risk acceptable to the respondent. Data were analyzed with an interval regression to estimate the maximum acceptable risk (MAR) of pyrexia to take the alternative treatment. With a 63% risk of pyrexia, 26% of stage III patients would take the alternative treatment over the reference when efficacy was unknown, compared with 88% when the chance of recurrence was 12%. The mean MAR of pyrexia when efficacy was unknown was 34% compared with 85% when it was known, indicating that respondents were willing to accept a higher risk of pyrexia when they knew the estimated efficacy was better. When patients are informed, they may choose to accept higher adverse event risks for a better chance of recurrence.
