Patient preferences for second-line treatment options in diffuse large B-cell lymphoma: A discrete choice experiment.

Abstract

e19558 Background: Standard of care (SOC) treatment in second-line (2L) large B-cell lymphoma (LBCL), including diffuse LBCL (DLBCL), involves salvage chemotherapy followed by autologous hematopoietic cell transplant (AHCT) for those with chemo-sensitive disease. However, many patients do not respond adequately to chemotherapy or are otherwise ineligible for AHCT. Chimeric antigen receptor T-cell (CAR T) therapy is a promising 2L therapy for LBCL that differs from SOC agents in terms of mechanism of action, therapeutic benefit, and safety profile. Given these differences, this discrete choice experiment (DCE) quantified 2L treatment preferences among patients with DLBCL. Methods: We conducted an online DCE with patients with DLBCL residing in the United States (US) and Europe (United Kingdom, France, Italy, Germany, and Spain). Attributes of 2L treatments were parameterized based on clinical trial data and included the probability (percent of patients) of surviving one year after treatment, the change in survival rate from one to three years, the risks of severe cytokine release syndrome (CRS) and neurological events, the risk of severe infection, and expected time until the patient’s functioning would return to pre-treatment levels. A willingness-to-accept measure was used to assess how much of an increase in one-year survival was needed for a patient to accept elevated risks of severe CRS and neurological events, which can be associated with CAR T treatment. Results: A total of 224 patients were included in the analysis (US: 105; Europe: 119). The mean age of respondents was 50 years (range 34 - 76); 74% were male, and 94% were actively receiving cancer treatment. Patients considered the probability of surviving one year after treatment to be the most influential treatment attribute, followed by risk of severe CRS/neurological events. The third most influential attribute was the change in probability of survival for three years post-treatment for US patients and time needed to return to pre-treatment functioning for European patients. The willingness-to-accept calculation found that patients required a 13-14 percentage point increase in the probability of surviving one year to accept a 28% risk of a serious neurological event and a 13% risk of serious CRS. Conclusions: Patients with DLBCL showed their willingness to accept increased risks of CRS and neurological events to achieve a greater probability of survival. This preference tradeoff (efficacy over risk of adverse events) has been shown previously for lymphoma patients. Patients also valued a quicker return to baseline functioning, which is notable given recent data on the quicker recovery of quality of life with CAR T compared with SOC. These patient preferences provide important context for 2L LBCL treatment decisions, and may lead to shared decision-making that reflects both clinical and patient priorities.