Oncologists and hematologists face significant challenges in managing the growing array of therapies for mantle cell lymphoma (MCL) and chronic lymphocytic leukemia (CLL), according to a recent cross-sectional study. The findings, published in Cancer Reports by Lazure and colleagues, reveal that capabilities to handle these treatments vary widely by country and clinical setting. The research, funded by Eli Lilly through AXDEV Global, surveyed 285 physicians across the United States, France, Germany, the United Kingdom, and Brazil to assess knowledge and confidence gaps.
Uneven Readiness for New Therapies
The study focused on physicians with at least two years of experience prescribing Bruton tyrosine inhibitors (BTK inhibitors) for MCL or CLL. It expanded on a previous first-phase analysis covering only the US, France, and Germany by including data from Brazil and introducing a focus on patient engagement and shared decision-making. While the pool of participating doctors was relatively small—285 respondents—covering five distinct healthcare markets highlights the disparities in how new treatments are being adopted globally.
In MCL specifically, the data showed a sharp decline in readiness for newer therapies. More than half of the respondents, or 54 percent, reported suboptimal skills in monitoring and managing side effects from chimeric antigen receptor (CAR) T-cell therapy. This deficit was particularly acute in community settings, with 72 percent of German doctors and 77 percent of Brazilian physicians reporting these gaps. By comparison, skills gaps around managing BTK inhibitors in MCL affected only 30 percent of the group.
Adjusting treatment based on guidelines or patient tolerance proved difficult for many. About 42 percent of respondents reported suboptimal skills in this area for MCL, compared to 33 percent for CLL. The gap widened in academic settings, with 53 percent of French academic physicians and 50 percent of UK community providers struggling to integrate patient preferences into treatment plans.
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The authors attribute these MCL-specific difficulties to uneven access and regulatory timelines. CAR T-cell therapies were approved in the US as early as 2017, but only recently became available in Brazil. “Approval of a novel therapy may occur long before it is integrated into national or international guidelines, institutional protocol, and clinical prescribing practices,” the authors explained.
Knowledge Gaps in CLL Management
For CLL, the primary challenge identified was a lack of understanding regarding adverse-effect profiles of newer agents. Nearly half of the respondents, 49 percent, reported suboptimal knowledge of noncovalent BTK inhibitor side effects. These levels reached 68 percent in Brazil and 70 percent in the UK. Overall, 34 percent of participants acknowledged gaps in their knowledge of BTK inhibitors approved after 2018.
Confusion also exists regarding how these drugs compare to BCL-2 inhibitors. Almost half of all participants (49 percent) disagreed with the statement that BCL-2 inhibitors and BTK inhibitors share similar adverse effect profiles but differ in overall survival. This reflects a misunderstanding of the comparative risk between these treatment classes.
There was also notable disagreement about the safety of using BTK inhibitors in patients already on anticoagulants. Roughly a quarter of respondents believed the risks frequently outweighed the benefits, despite evidence supporting the safe coadministration of these drugs. In contrast to MCL, the skills gaps in CLL were comparatively smaller, with 31 to 33 percent of respondents reporting suboptimal skills in risk stratification and guideline updates. Germany’s community settings again showed raised gaps, reaching 43 percent.
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The Patient Communication Gap
Shared decision-making emerged as a consistent weakness across all five countries. Fifty-eight percent of respondents said they rarely or never considered patients’ concerns about treatment safety. Similarly, 42 percent admitted they rarely or only sometimes considered how side effects might impact adherence. Only 25 percent of doctors regularly asked patients about their therapy preferences, a figure that rose to 47 percent in France.
Confidence in discussing clinical data was also lacking. Suboptimal confidence in discussing risks, benefits, and survival outcomes was reported by 21 percent of respondents overall, including 28 percent in France. The authors noted that even where clinical knowledge exists, translating it into patient-centered conversations remains inconsistent.
Patients have indicated a desire for education and support in self-management practices, according to the study. While patients report positive experiences with BTK inhibitors and venetoclax, they also experience significant adverse effects. Side effect management and communication and collaboration are known areas where [oncologists/hematologists] and other providers struggle, the researchers wrote.
