Practice Patterns Inform Patient-Centered Approaches for the Integration of BTK Inhibitors in Frontline Mantle Cell Lymphoma

BACKGROUND: Several covalent Bruton's tyrosine kinase inhibitors (BTKis) are approved to manage relapsed and/or refractory mantle cell lymphoma (MCL) and have shown encouraging results. In the frontline setting these agents have the potential to improve outcomes. Given the rapidly evolving landscape in MCL treatment, there is a need to better understand how novel treatment strategies are integrated into community practice settings. A two-phase educational initiative was designed to analyze current practice patterns and educate clinicians on the clinical data supporting the use of BTKis in frontline MCL. The results from the first phase of the educational initiative are reported.

METHODS: The first phase of this initiative consisted of a deep-dive survey that was administered between March and June 2024. The survey was disseminated to treating physicians, verified by ICD-10 codes through a partnership with IQVIA, and included questions that focused on evaluating current practice patterns, barriers, attitudes, and challenges in the management of newly diagnosed MCL.

The second phase was a 1-hour live and on-demand activity led by a panel of MCL experts. The program was broadcasted on Medlive.com in June 2024 and will remain available for 1 year. The panel addressed the current treatment practices among oncologists and challenges with integrating BTKis. Knowledge and competence questions were administered pre-, immediately post-activity, and in post-program evaluations.

RESULTS: The phase one survey was completed by 77 oncologists that manage patients with MCL. Of those respondents, 71% practiced in the community setting, 26% practiced in an academic setting, and 3% other. Findings from the survey showed that 61% and 55% of clinicians reported routinely assess TP53 mutations and Ki67, respectively. The Mantle Cell Lymphoma International Prognostic Index (MIPI) prognostic scoring system was routinely assessed in 58% of patients. MIPI-c, which combines the clinical factors from MIPI and the Ki67 index, has not been widely integrated in the community setting, with only 15% of respondents routinely utilizing it in practice. Only 37% of clinicians reported that they always educate their patients about prognosis based on molecular testing. These results suggest wider adoption of prognostic tools is needed to inform treatment decisions.

The top challenges with treatment decision-making for newly diagnosed MCL were selecting therapies based on current evidence (59%), individualizing treatment plans (45%), and access to clinical tools to stratify patients (30%). The top patient concerns about treatment as reported by clinicians were understanding their MCL and the available treatment options (51%), worry about the potential risks of treatment (51%), and choosing a treatment plan that is best for them (47%). Clinicians identified managing side effects (45%) as the top challenge in managing patients with newly diagnosed MCL. Although 53% of clinicians reported they currently use BTKis to manage MCL, only 38% noted that they are confident in their ability to incorporate them in the frontline setting. The top three identified barriers to integrating novel BTKis were gaining access to oral targeted therapies (38%), difficulty recognizing disease progression (38%), and lack of experience with oral targeted therapies (37%).

CONCLUSIONS: This initiative provided insights into current practices and perceptions for frontline MCL management. There are gaps remaining for clinicians' communication with patients regarding molecular testing. Patients with high-risk features such as TP53 mutations or high Ki67 (≥30%) proliferation index have historically faced a lack of consensus frontline treatment. Risk stratification is crucial in a patient-centered approach to the treatment of MCL. Our data suggest that many clinicians are challenged with integrating BTKis into the care of patients with newly diagnosed MCL, which is partly due to access to novel therapies and lack of knowledge of evidence-based strategies. Continuing educational activities designed to address these practice gaps are needed for clinicians that care for patients with newly diagnosed MCL.

The initiative was supported by an independent educational grant from AstraZeneca Pharmaceuticals.

Kumar:Kite Pharmaceuticals, Janssen: Honoraria; Astra Zeneca: Honoraria, Research Funding; BridgeBio Pharmaceuticals: Current equity holder in publicly-traded company; Genentech, Inc.: Consultancy, Honoraria, Research Funding; Loxo Oncology/Lily Pharmaceuticals: Honoraria, Research Funding; Seattle Genetics: Research Funding; Adaptive Biotechnologies, Celgene, Pharmacyclics: Research Funding; Abbvie Pharmaceuticals: Research Funding. Matasar:IMV Therapeutics: Honoraria; Takeda: Honoraria; Pfizer: Honoraria; Epizyme: Honoraria; Seattle Genetics: Consultancy, Honoraria, Research Funding; Pharmacyclics: Consultancy, Honoraria, Research Funding; Kite: Honoraria; Johnson & Johnson: Consultancy, Honoraria, Research Funding; BMS/Celgene: Honoraria; AstraZeneca: Honoraria; ADC Therapeutics: Honoraria; Immunovaccine Technologies: Research Funding; Merck: Current equity holder in publicly-traded company; Allogene: Membership on an entity's Board of Directors or advisory committees; Genmab: Membership on an entity's Board of Directors or advisory committees; GM Biosciences: Consultancy, Research Funding; Genentech: Consultancy, Honoraria, Research Funding; Bayer: Consultancy, Honoraria, Research Funding; Roche: Consultancy, Honoraria, Research Funding; Regeneron Pharmaceuticals, Inc.: Honoraria.