Abstract
Introduction. Multiple regimens listed in current guidelines are reasonable options for treatment of MCL; however, guidance for selecting patient-specific regimens are needed. We sought to determine if expert recommendations, delivered as an online decision support tool, would change or confirm treatment decisions of community practitioners.
Methods. An online decision support tool was developed with input from 5 experts to provide therapy recommendations for patient scenarios in newly diagnosed or relapsed/refractory MCL. The online tool included expert insight on 120 scenarios based on criteria such as age, fitness, histology, LDH, and Ki-67 as well as previous therapy and duration of response. Tool users were asked to enter specific patient criteria and their intended management for each case. The tool then showed 5 MCL expert recommendations for the user-entered patient case, and the users were asked to indicate if the expert recommendations changed their intended approach. An analysis of expert recommendations and user-selected therapy was performed.
Results. At interim analysis, this online tool was used by over 160 individuals, entering more than 235 patient scenarios. For users reporting on the tool's clinical impact, 73% indicated expert recommendations confirmed or changed their intended therapy and 21% indicated that there were barriers to implementing those recommendations. Data from the online tool showed areas of consensus and controversy in treating patients with MCL (Table 1). In addition, nearly 20% of users were unsure of the optimal use of additional therapy (eg, transplant or maintenance therapy) for their patients.
Conclusions. An online tool providing expert advice on specific MCL patient scenarios confirmed or changed the clinical approach for a majority of community practitioners. Online decision support tools may increase the number of clinicians making optimal treatment decisions for patients with MCL, especially when new data, agent indications, and guideline updates must be considered. Detailed comparisons of expert and user responses from the online tool will be presented.
Summary of Treatment Choices by Experts and Tool Users for Select Patient Scenarios
| ND MCL: ≤ 75 yrs, fit . | Expert, % . | Users, % . |
|---|---|---|
| Bendamustine-R | 44 | 17 |
| R-HyperCVAD or HyperCVAD | 44 | 28 |
| R-CHOP | 0 | 27 |
| Other aggressive chemotherapy | 0 | 21 |
| Other less aggressive chemotherapy | 11 | 1 |
| Unsure | 0 | 3 |
| ND MCL: > 75 yrs or less fit | Expert, % | Users, % |
| Bendamustine-R | 85 | 56 |
| R-HyperCVAD or HyperCVAD | 0 | 6 |
| R-CHOP | 0 | 25 |
| Other less aggressive chemotherapy | 10 | 6 |
| Observation | 5 | 0 |
| Unsure | 0 | 6 |
| R/R MCL: < 60 yrs, fit | Expert, % | Users, % |
| Ibrutinib | 34 | 22 |
| Bendamustine-R | 19 | 19 |
| Lenalidomide-R | 25 | 11 |
| R-HyperCVAD or HyperCVAD | 0 | 11 |
| R-CHOP | 0 | 4 |
| Other aggressive chemotherapy | 0 | 7 |
| Other less aggressive chemotherapy | 15 | 4 |
| Unsure | 0 | 19 |
| R/R MCL: < 60 yrs, unfit or > 60 yrs regardless of fitness | Expert, % | Users, % |
| Ibrutinib | 72 | 34 |
| Bendamustine-R | 13 | 17 |
| Lenalidomide-R | 0 | 6 |
| R-HyperCVAD or HyperCVAD | 0 | 8 |
| R-CHOP | 4 | 4 |
| Other less aggressive chemotherapy | 8 | 2 |
| Other chemotherapy-free regimens | 4 | 17 |
| Unsure | 0 | 4 |
| ND MCL: ≤ 75 yrs, fit . | Expert, % . | Users, % . |
|---|---|---|
| Bendamustine-R | 44 | 17 |
| R-HyperCVAD or HyperCVAD | 44 | 28 |
| R-CHOP | 0 | 27 |
| Other aggressive chemotherapy | 0 | 21 |
| Other less aggressive chemotherapy | 11 | 1 |
| Unsure | 0 | 3 |
| ND MCL: > 75 yrs or less fit | Expert, % | Users, % |
| Bendamustine-R | 85 | 56 |
| R-HyperCVAD or HyperCVAD | 0 | 6 |
| R-CHOP | 0 | 25 |
| Other less aggressive chemotherapy | 10 | 6 |
| Observation | 5 | 0 |
| Unsure | 0 | 6 |
| R/R MCL: < 60 yrs, fit | Expert, % | Users, % |
| Ibrutinib | 34 | 22 |
| Bendamustine-R | 19 | 19 |
| Lenalidomide-R | 25 | 11 |
| R-HyperCVAD or HyperCVAD | 0 | 11 |
| R-CHOP | 0 | 4 |
| Other aggressive chemotherapy | 0 | 7 |
| Other less aggressive chemotherapy | 15 | 4 |
| Unsure | 0 | 19 |
| R/R MCL: < 60 yrs, unfit or > 60 yrs regardless of fitness | Expert, % | Users, % |
| Ibrutinib | 72 | 34 |
| Bendamustine-R | 13 | 17 |
| Lenalidomide-R | 0 | 6 |
| R-HyperCVAD or HyperCVAD | 0 | 8 |
| R-CHOP | 4 | 4 |
| Other less aggressive chemotherapy | 8 | 2 |
| Other chemotherapy-free regimens | 4 | 17 |
| Unsure | 0 | 4 |
*Treatments selected by <3% of either experts or users were not included in summary table.
Flowers:Genentech: Other: unpaid consultant, Research Funding; Celgene: Other: unpaid consultant, Research Funding; Abbott: Research Funding; Millennium/Takeda: Research Funding; Algeta: Consultancy; Optum Rx: Consultancy; Biogen Idec: Other: unpaid consultant; Roche: Other: unpaid consultant; Spectrum: Research Funding; Gilead: Research Funding. Goy:Acerta: Membership on an entity's Board of Directors or advisory committees; Celgene: Honoraria, Membership on an entity's Board of Directors or advisory committees; Takeda: Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Pharmacyclics/JNJ: Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau. Leonard:Weill Cornell Medical College: Employment; Genentech: Consultancy; Medimmune: Consultancy; AstraZeneca: Consultancy; Spectrum: Consultancy; Boehringer Ingelheim: Consultancy; Vertex: Consultancy; ProNAI: Consultancy; Biotest: Consultancy; Seattle Genetics: Consultancy; Pfizer: Consultancy; Mirati Therapeutics: Consultancy; Gilead: Consultancy; Novartis: Consultancy. Vose:GlaxoSmithKline: Research Funding; Genentech: Research Funding; Celgene: Research Funding; Janssen Biotech: Research Funding; Incyte Corp: Research Funding; Allos Therapeutics/Spectrum: Research Funding; US Biotest, Inc: Research Funding; Acerta Pharma: Research Funding; Bristol-Myers Squibb: Research Funding. Mortimer:AstraZeneca: Other: spouse is an employee of and has equity ownership in . Armitage:Roche: Consultancy; Spectrum: Consultancy; Celgene: Consultancy; GlaxoSmithKline: Consultancy, Membership on an entity's Board of Directors or advisory committees; Tesaro Bio, Inc: Membership on an entity's Board of Directors or advisory committees; Conatus: Consultancy, Membership on an entity's Board of Directors or advisory committees; Ziopharm: Consultancy.
Author notes
Asterisk with author names denotes non-ASH members.
