Jiachen Shao, Hui Peng, Li Zhou, Lei Liu, Xiao Ma, Xue Zhang, Zhiming Li, Shunping Li
OS emerged as the most important attribute for R/R MCL treatment after cBTKi for both patients and physicians. Preference differences were observed among patients and physicians. These insights may facilitate shared decision making and inform drug development and policy to enhance treatment adherence and improve health outcomes.
BACKGROUND: Mantle cell lymphoma (MCL) is a rare subtype of non-Hodgkin lymphoma with a high relapse rate and poor treatment outcome. Treatment options for patients with relapsed/refractory (R/R) MCL remain limited and are associated with heterogeneous efficacy and safety profiles, especially in those previously treated with covalent Bruton tyrosine kinase inhibitors (cBTKi). This study aimed to elicit patients' and physicians' preferences for treatments for R/R MCL after cBTKi failure.
METHODS: From January to March 2025, a discrete choice experiment was conducted through face-to-face paper-based surveys in China. Respondents completed choice tasks comparing hypothetical treatments defined by seven attributes: duration of response (DOR), overall survival (OS), risk of serious infections, risk of cytokine-release syndrome (CRS), impact of chronic adverse events (AEs) on daily life, risk of discontinuation due to AEs, and treatment procedure. Mixed logit models were employed, and relative attribute importance (RAI) was calculated. Maximum acceptable risk analysis and scenario analysis were conducted to reveal the trade-offs respondents were willing to make. Preference heterogeneity was also explored through subgroup analysis.
RESULTS: A total of 150 patients and 150 physicians were included in the analysis. Most patients (76.0%) had previously experienced failed cBTKi, and all physicians had experience in treating patients with R/R MCL in whom cBTKi had failed. OS (RAI = 35.3% [95% CI 29.2-41.3] for patients, 34.5% [95% CI 28.8-40.1] for physicians) was prioritized as the most important attribute by both patients and physicians, followed by impact of chronic AEs on daily life (25.2% [95% CI 20.9-29.5], 22.0% [95% CI 18.0-26.0]) and DOR (17.4% [95% CI 11.4-23.4], 19.0% [95% CI 13.0-25.0]). Patients and physicians were both willing to accept a higher risk of CRS in exchange for longer OS and DOR. Physicians also valued the risk of discontinuation due to AEs (RAI = 4.8% [95% CI 1.4-8.3]), while patients did not exhibit significant preferences for it.
CONCLUSION: OS emerged as the most important attribute for R/R MCL treatment after cBTKi for both patients and physicians. Preference differences were observed among patients and physicians. These insights may facilitate shared decision making and inform drug development and policy to enhance treatment adherence and improve health outcomes.