Despite access barriers, physicians prefer CAR-T for treatment of advanced B-cell lymphoma
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Key findings:
- Physicians most frequently recommended CAR-T for third-line treatment of relapsed or refractory DLBCL.
- Nearly one-third of patients for whom CAR-T had been recommended did not receive the treatment.
Physicians recommended chimeric antigen receptor T-cell therapy more frequently than any other regimen for third-line treatment of relapsed or refractory diffuse large B-cell lymphoma, survey results showed.
However, nearly one-third of patients for whom CAR-T had been recommended did not receive the treatment, findings from a poll of health care professionals presented at National Comprehensive Cancer Network’s Annual Conference revealed.
Additionally, survey respondents noted a strategy preference for treating until disease progression rather than for a fixed duration — particularly for patients refractory to previous therapy.
“Physician choice in selecting the right therapy for their patients is important,” Betsy J. Lahue, MPH, founder and CEO of Alkemi, a consulting firm focused on health economics and outcomes research, told Healio. “Physicians have limited treatment options with different attributes, and often patient preferences and access factors are important considerations.”
Background
Lahue and colleagues examined physician treatment preferences for third-line therapy for adults with relapsed or refractory DLBCL.
They also aimed to determine why patients recommended for CAR T cells did not receive the treatment.
“Given the recent approvals and anticipated approvals of novel therapies for third-line relapsed or refractory diffuse large B-cell lymphoma, we sought to understand which factors drive real‐world treatment decisions,” Lahue said.
Methodology
Lahue and colleagues conducted a web-based survey of 75 U.S.-based physicians with more than 1 year of experience who specialized in hematology or oncology.
Most respondents (62.7%) had at least 10 years of experience treating patients.
All participants had experience prescribing or referring patients for CAR T-cell therapy and had treated at least three patients in the past 12 months with third-line therapy for relapsed or refractory DLBCL.
Determining real-world treatment preferences among physicians who treat patients with relapsed and refractory DLBCL served as the primary objective of this study.
Key findings
Nearly all (94.7%) survey respondents indicated they had prescribed CAR T cells for third-line treatment.
More than three-quarters (76%) reported prescribing the combination of polatuzumab vedotin-piiq (Polivy, Genentech), bendamustine and rituximab (Rituxan; Genentech, Biogen).
Other frequently prescribed treatments included tafasitamab (Monjuvi; MorphoSys, Incyte) plus lenalidomide (56%); chemotherapy (50.7%), and hematopoietic stem cell transplantion (40%).
Respondents indicated they treated a mean 39.9 ± 69.2 patients for relapsed or refractory DLBCL over the prior 12 months.
Physicians reported prescribing CAR-T to 36.6% of adults who required third-line therapy, with 49.1% being referred to a CAR-T center for treatment.
However, nearly one-third of patients (30.1%) prescribed or referred for CAR-T never received treatment. Common factors cited for not receiving CAR-T included a lack of willingness to travel for treatment (49.3%), post-referral ineligibility (48%) and patient preference for alternative treatment (37.3%).
Survey respondents preferred a strategy that treated until disease progression rather than a fixed duration across all patient types. Most respondents (57.3%) cited maintaining suppression of malignant cells as the primary benefit, followed by longer duration of response (45.3%) and stabilized disease (42.7%).
Clinical implications
The patients considered in this survey already experienced disease progression or relapse after previous therapies and had limited treatment options.
This makes the subsequent choice regarding the next line of therapy a unique management challenge for clinicians, Lahue said.
“This study provides insights into how some physicians in the U.S. make their treatment choices among this patient population, which can help inform and empower other clinicians when faced with a similar decision,” Lahue told Healio. “Our research points to the patient preference factors and the need for more insights from the patients themselves so that physicians can consider optimizing care experiences.”
Future studies should examine patient experiences “to optimize treatment pathways and oncology care outcomes,” Lahue added. “It would be interesting to understand the patient’s perspective of third-line treatment options — including their preference for treatment duration and treatment format.”
For more information:
Betsy J. Lahue, MPH, can be reached at betsy.lahue@alkemihealth.com.
Collapse
Gao W, et al. Abstract HSR23-118. Presented at: NCCN Annual Conference; March 31-April 2, 2023; Orlando.
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