Survey Explores Prescriber Perceptions and Preferences Regarding First Line Therapy for MCL

Findings from a survey revealed prescriber willingness to use other therapeutic options in patients with mantle cell lymphoma (MCL), a heterogeneously aggressive, generally incurable B-cell malignancy accounting for an estimated 5% of non-Hodgkin lymphomas according to a recent publication in the journal, Value in Health.

MCL is often diagnosed late-stage and  lacks a standard of care. Age, health, and disease stage guide treatment decisions. multiagent induction chemoimmunotherapy followed by stem cell transplant (SCT) is employed as treatment for younger or healthier patients. In general, older or less healthy patients receive lower-intensity/maintenance regimens.

The survey was conducted by C Brown- Bickerstaff, MD, Cardinal Health, Dublin, Ohio and colleagues. They aimed to evaluate first line (1L) therapy preferences for treatment-naïve patients with MCL in routine practice and perceptions surrounding benefits and risks of the lenalidomide plus rituximab plus venetoclax triplet (LVR) regimen.

The survey was conducted in August 2021 among US-based hematologists/oncologists. The survey assessed 1L therapy preferences and perceptions surrounding LVR as an alternative to chemotherapy and potential barriers to its use. The respondents were informed that the data would be anonymized.

The results revealed that of the physicians managing MCL patients, 38 responded to 5 MCL-related questions. The average years in practice were 17 (range 4-43), 74% were in community practice, and US regional distribution was 39% Northeast, 32% South, 18% West, and 11% Midwest. The BR regimen was preferred by 79% for patients aged 65 years or older, whereas BR (29%) or high-dose therapy followed by autologous SCT (26%) was preferred for younger patients.

With regard to safety and efficacy, 47% were very likely and 50% were to some extent likely to prescribe LVR and 40% indicated that offering a chemotherapy-free option was the most compelling reason, followed by the 86% 12-month progression-free survival (29%). The 93% rate of grade 3 treatment-emergent adverse events (AEs) which was reported as 74% and cytopenia (47%) were noted as the leading causes of concern with regard to LVR (not mutually exclusive).

The authors concluded that based on the survey findings, physicians were extremely open to prescribing LVR triplet therapy despite the elevated incidence of AEs and cytopenia rates. They also noted that the findings emphasize provider willingness to use expanded therapeutic options in this patient population, especially the chemotherapy-free alternative with venetoclax.

Reference

Brown-Bickerstaff C,  Balanean, A M.P.H., Klink A, Gajra A, SA25 Physician Prescribing Preferences and Perceptions Surrounding First-LINE (1L) Noncytotoxic Combination Therapy for Mantle Cell Lymphoma (MCL), Value in Health, Volume 25, Issue 7, Supplement, 2022, https://doi.org/10.1016/j.jval.2022.04.1691.