HSR23-118: Assessment of Physician Treatment Preferences for Relapsed or Refractory (R/R) Diffuse Large B-Cell Lymphoma (DLBCL)

Background: While several therapies were recently approved for R/R DLBCL, there is no standard of care and limited evidence regarding healthcare provider (HCP) views on third-line (3L) treatment. Patients receive a variety of therapies, including chemotherapy, chimeric antigen receptor T cell therapy (CAR T), and other novel agents. This web-based survey describes real-world HCP treatment preferences and factors that influence 3L treatment decisions for patients with R/R DLBCL. Methods: US HCPs who had ≥1 year of experience as a hematologist/oncologist, had treated ≥3 patients with a 3L therapy for R/R DLBCL within the past 12 months, and had experience prescribing/referring patients for CAR T were included. Survey responses were based on the HCPs’ best recall and took approximately 15–20 minutes to complete. Descriptive statistics assessed responses, including frequencies and proportions for categorical variables, and means, standard deviations (SDs), medians, and interquartile ranges (IQRs) for continuous variables. Results: A total of 75 HCPs completed the survey, with the majority (62.7%) having >10 years of experience. Overall, HCPs treated a mean (SD) of 39.9 (69.2) patients with R/R DLBCL over the past 12 months. Of eligible 3L patients, HCPs reported prescribing CAR T to 36.6% of patients and referring 49.1% of patients to a CAR T treatment center. Of these, 30.1% of patients recommended (prescribed + referred) did not ultimately receive CAR T. HCPs reported that the most common reasons for CAR T-eligible patients to not receive treatment as indicated were lack of willingness to travel for treatment (49.3%), post-referral ineligibility (48.0%), and patient preference for alternative treatment (37.3%). Among patients who received CAR T, HCPs estimated that 21.6% of patients were refractory to CAR T and 28.0% relapsed post-CAR T. While 44.0% of HCPs were indifferent to treatment formats, they perceived a large patient preference for subcutaneous (58.7%) versus intravenous (12.0%) administration. Across R/R patient types, HCPs preferred treating to progression over fixed-duration regimens and 57% cited the benefit of suppressing malignant cells. Conclusions: HCPs reported logistical challenges with CAR T and preferences for treat-to-progression subcutaneous therapies in 3L DLBCL, especially for patients with relapsed refractory disease. Survey findings suggest an ongoing need for therapies better aligned with HCP and patient preferences.