Study Reveals Patient-Oncologist Gaps in Post-cBTKi CLL Treatment Preferences | Targeted Oncology
A significant gap exists between how oncologists and patients prioritize treatment options for chronic lymphocytic leukemia (CLL) following covalent Bruton tyrosine kinase inhibitor (cBTKi) therapy. New research indicates that while physicians maintain a consistent focus on clinical outcomes, patients exhibit a wide variety of individual priorities.
The Divergence in Treatment Priorities
A US-based study involving 300 participants—150 CLL patients and 150 hematologists/oncologists—used a discrete choice experiment to quantify treatment trade-offs. The research evaluated key attributes including progression-free survival (PFS), the risk of adverse effects, treatment duration, and the risk of discontinuation due to intolerability.
Oncologists demonstrated strikingly consistent preferences, with efficacy serving as the primary driver. Progression-free survival accounted for a relative attribute importance (RAI) of 44.7%, while the risk of discontinuation due to intolerability contributed 22.9%.
Interestingly, the choice between fixed-duration and continuous therapy was a low priority for physicians, representing only 3.6% of their choice behavior. This hierarchy remained constant regardless of the patient’s age or the reason for the previous cBTKi discontinuation.
Diverse Patient Perspectives
Patients presented a more complex and heterogeneous set of priorities. While the median duration of PFS was valued by many with an RAI of 49.9%, it was not the sole driver for the entire group.
Different patients placed significant weight on other factors, such as reducing the risk of adverse effects (RAI 12.2%) or minimizing the likelihood of discontinuation due to intolerability (RAI 16.3%). Others prioritized the frequency and mode of administration or the overall duration of the treatment.
The study found that these varying preferences could not be linked to sociodemographic factors or specific disease characteristics. This suggests that standard clinical proxies are insufficient for predicting what an individual patient will prioritize.
Implications for Clinical Care
This divergence in priorities has direct implications for shared decision-making in second- and later-line settings. Current available options, such as the BCL2 inhibitor venetoclax (Venclexta) and the noncovalent BTKi pirtobrutinib (Jaypirca), offer different profiles regarding PFS, administration, and adverse effect risks.
Because these drug profiles mirror the varied attributes patients value, personalized treatment planning is essential. Clear communication is required to ensure that the chosen therapy aligns with the personal goals of the patient.
Potential Future Developments
As the number of therapies for relapsed/refractory CLL expands, providers may need to adopt more flexible communication strategies. Additional research could be conducted to better understand the specific factors that drive these differences in patient preferences.
The availability of a broader range of treatment options may become increasingly important to address the diverse needs observed among the patient population.
Frequently Asked Questions
Who participated in the preference study?
The study included 300 participants based in the United States, consisting of 150 patients with CLL and 150 hematologists/oncologists who treat CLL.
What was the primary driver for oncologists when selecting therapy?
Progression-free survival (PFS) was the dominant driver for oncologists, with a relative attribute importance of 44.7%.
Can a patient’s demographic profile predict their treatment preferences?
No. The study found that preference subsets could not be attributed to observed sociodemographic factors or disease characteristics, meaning there is no readily identifiable profile to predict individual priorities.
How do you balance clinical efficacy with personal quality-of-life preferences when discussing healthcare decisions?