A new study published in Future Oncology reveals that patients with chronic lymphocytic leukemia (CLL) prioritize treatments that offer improved progression-free survival (PFS) over other therapeutic considerations. The findings emerge from a discrete-choice experiment survey involving 229 participants, offering crucial insights into patient preferences that could reshape treatment decision-making.
Patient Treatment Preferences and Priorities
The survey found that patients placed the highest value on treatments that could increase the likelihood of 2-year PFS from 70% to 90%, particularly when confirmed through measurable residual disease (MRD) testing rather than routine testing. This preference for improved survival outcomes significantly outweighed other treatment attributes.
In terms of administration preferences, patients favored daily oral medications over intravenous infusions given every 4 weeks. They also showed a clear preference for fixed-duration treatments lasting 6 months compared to open-ended therapy continued until disease progression.
Study Demographics and Methodology
The research, led by Arliene Ravelo Mangalindan, MPH, Director of Oncology Health Economics & Outcomes Research at Genentech, recruited participants through the CLL Society. The median age of respondents was 67 years, with the majority being White (95.2%) and female (59.4%). Among the participants who had received prior CLL therapy, 71.1% were actively undergoing treatment at the time of the survey.
Risk Tolerance and Treatment Considerations
A notable finding was patients' willingness to accept certain treatment risks in exchange for better outcomes. The risk of tumor lysis syndrome (TLS) ranked as the least concerning factor among respondents, who were willing to accept over a 3% risk of TLS in exchange for improvements in PFS, treatment duration, and administration mode.
The survey also evaluated attitudes toward various adverse effects. Patients viewed the reduction in atrial fibrillation risk (from 10% to 0%) as approximately equivalent in importance to reducing fatigue risk (from 35% to 0%).
Treatment Profile Preferences
When presented with different treatment profiles, respondents showed a stronger preference for attribute levels based on the combination of venetoclax plus obinutuzumab compared to other treatment options. This preference held consistent across different age groups and treatment experience levels, with no statistically significant differences observed in predefined subgroup analyses.
Implications for Clinical Practice
These findings provide valuable insights for healthcare providers engaged in shared decision-making with CLL patients. The strong patient preference for treatments that optimize PFS, coupled with the desire for oral administration and fixed treatment duration, suggests a need to carefully balance efficacy with quality of life considerations in treatment selection.
The research underscores the importance of incorporating patient preferences into treatment planning, particularly as the therapeutic landscape for CLL continues to evolve with new targeted therapies and combination approaches.
