Clinical and non-clinical factors in oncology decision-making

Medscape Oncology recently published a summary of a “debate” held at an international lymphoma conference in Switzerland (https://www.medscape.com/viewarticle/cll-hematologists-face-best-long-term-strategy-2025a1000i62) regarding the best choice of first-line therapy in chronic lymphocytic leukemia (CLL) between second-generation BTK inhibitors and the BCL-2 inhibitor venetoclax.  The hematologists on either side of this debate clearly summarized the efficacy and safety profiles of both choices, and this article is a terrific introduction for the market researcher who needs to understand the current first-line landscape in CLL.

It is worth noting that there is no clear consensus regarding which option is superior in this setting (which is why the debate was held in the first place).  To conclude the article, Medscape interviewed a third expert hematologist, who noted that both BTK inhibitors and venetoclax are reasonable options for most patients, and treatment choice should therefore be guided by the patient presentation, disease biology/risk, and patient preference.

The oncologists I have interviewed over the years have told me time and time again that efficacy is the paramount factor when they are treating patients, provided the toxicities and effects on quality of life are not too severe.  But in this case, there is no obvious choice in terms of efficacy or safety, and other “tertiary” factors can guide oncologists’ decisions.

‍

It is important for researchers and marketers to remember that both clinical and non-clinical factors can affect treatment choice, especially when differences in efficacy are murky.

• Clinical factors: Dr. Bhat, the physician Medscape contacted for comment, noted that patients with certain cardiovascular comorbidities might want to avoid BTK inhibitors, while those with renal dysfunction might not be the best candidates for venetoclax.
• Non-medical factors can also be relevant, such as whether a patient would prefer time-limited therapy or an all-oral regimen, how long a patient would need to travel to come to an infusion center, or whether the patient’s insurance makes a particular treatment more affordable or more readily available.

Patients especially may not be aware of these factors or may lack the vocabulary to ask about them.  In these circumstances, communications with both physicians and patients should involve language that they can use to discuss or explain these important aspects of care.

‍