Physician Considerations When Choosing a Third-Line DLBCL Treatment

Patrick Connor Johnson, MD, an instructor in Medicine at the Dana-Farber Cancer Institute, discusses what physicians take into consideration when considering third-line treatment options in diffuse large B-cell lymphoma (DLBCL).

According to Johnson, DLBCL is the most common type of non-Hodgkin lymphoma, with a number of new treatment options approved in recent years. However, little data exists on what physicians take into consideration when making treatment decisions.

A survey of hematology oncologists across Europe and the United states found that progression-free and overall survival where the most important considerations taken when making treatment decisions. Additionally, duration of response and adverse events were also of high priority. According to Johnson, the logistics of therapy such as the need for hospitalization and distance were low on the list of priorities. Generally, little differentiation was seen across countries.

0:08 | Diffuse large B-cell lymphomas is the most common non-Hodgkin lymphoma, and there's been a number of different new treatment options, particularly in the third line or later setting that have been FDA approved and an overall EMA approved in recent years. I'm including the advent of CAR T-cell therapy. And so, therapy selection has become much more complex. Despite this, we don't have a lot of data to understand what physician perspectives are in respect to making treatment selection in this setting. And so that was really the background for why we wanted to assess physician perspectives and respect to key treatment attributes.

0:43 | This study was conducted as a single point in time survey. It did cross multiple countries, France, Germany, Italy, Spain, the UK, and the United States, of practicing hematologist, hematology oncologist, and medical oncologist who'd seen diffuse large B cell lymphoma patients a minimum of five per month. And we asked them to rank their top 7 treatment attributes from a preselected list. This was almost 240 physicians. A third of these surveyed physicians worked in the academic setting. Most of these physicians referred to CAR T-cell therapy centers for that specific treatment. And the highlights in terms of what physicians ranked are, they really favored progression-free survival, overall survival, duration of response, adverse events, including severe adverse events, the chance of a complete response and patient quality of life as the high attributes. And conversely, frequency of administration, hospitalization requirements, so the logistics of therapy, were uncommonly cited as important treatment attributes, both from a physician perspective, and from their perspective of the patient's acceptability of these. And this was really true across countries that were really minor variations by country. So, there's pretty general agreement on the top attributes when selecting these treatments.