Study Measures Both Patient and Physician Preferences After Covalent BTK Inhibitors in R/R MCL

Despite advances in recent years, treatment choices remain limited in mantle cell lymphoma (MCL), a rare subtype of non-Hodgkin lymphoma with a high relapse rate and poor treatment outcomes. Choices are especially limited for patients with relapsed/refractory (R/R) disease, and therapies vary widely in efficacy and safety. This especially true for patients moving on beyond covalent Bruton tyrosine kinase (BTK) inhibitors.

With this in mind, authors primarily from Shandong University and Eli Lilly in China conducted a study of patient patients’ and physicians’ preferences for treatments for R/R MCL after patients had been treated with covalent BTK inhibitors. Results appeared recently in The Patient.

Discrete Choice Experiment Method

Between January and March 2025, researchers conducted face-to-face paper surveys in China with 150 patients, 76% of whom had already experienced failure with a covalent BTK inhibitor, and 150 physicians experienced in treating R/R MCL after failure with 1 of these therapies. Respondents were presented with hypothetical treatment scenarios that varied across 7 attributes: duration of response (DOR), overall survival (OS), risk of serious infections, risk of cytokine-release syndrome (CRS), impact of chronic adverse events (AEs) on daily life, risk of discontinuation due to AEs, and treatment procedure. This study set out to understand what patients and physicians actually value when choosing among these limited options following a covalent BTK inihbitor, using a discrete choice experiment (DCE) methodology.

Overall Survival Is the Priority

A total of 150 patients and 150 physicians were included in the analysis. Most patients (76.0%) had previously experienced a failed covalent BTK inhibitor, and all physicians had experience in treating patients with MCL following after they relapsed for failed to respond to a covalent BTK inhibitor failed. RAI measures for the following attributes were as follows:

• OS was 35.3% for patients (95% CI 29.2–41.3) and 34.5% for physicians (95% CI 28.8–40.1)
• Impact of chronic AEs on daily life measured 25.2% for patients (95% CI 20.9–29.5) and 22.0% for physicians (95% CI 18.0–26.0)
• DOR measured 17.4% for patients (95% CI 11.4–23.4(, and 19.0% for physicians (95% CI 13.0–25.0).

Notably, both patients and physicians indicated they would accept a higher risk of CRS in exchange for gains in overall survival and duration of response. One meaningful divergence: physicians placed measurable weight on the risk of treatment discontinuation due to adverse events, while patients did not show a statistically significant preference on this attribute.

“OS emerged as the most important attribute for R/R MCL treatment after [covalent BTK inhibitors] both patients and physicians,” the authors concluded. “Preference differences were observed among patients and physicians. These insights may facilitate shared decision making and inform drug development and policy to enhance treatment adherence and improve health outcomes.”

Reference

Shao J, Peng H, Zhou L, et al. Treatment preferences for relapsed/refractory mantle cell lymphoma among patients and physicians in China: A discrete choice experiment. Patient. Published online August 14, 2026. doi:10.1007/s40271-026-00836-z