A recent study led by Duke Cancer Institute researchers sheds light on how patients with multiple myeloma weigh the risks and benefits of two promising treatment options: CAR T-cell therapy and bispecific T-cell engagers.
Multiple myeloma is an incurable blood cancer, but for many patients, it behaves more like a chronic illness. With median survival now exceeding 10 years for standard-risk patients, treatment decisions become increasingly nuanced over time. Patients often cycle through multiple lines of therapy, and their priorities may shift to favoring quality of life over longevity, especially after experiencing side effects.
This study – led Shelby Reed, MD, member of the DCI’s Cancer Prevention and Control program, and Thomas LeBlanc, MD, director of the Duke Cancer Patient Experience Program – aimed to better understand how patients prioritize the trade-offs between two novel classes of therapies.
The research team presented patients with hypothetical treatment scenarios that varied in terms of risks and benefits. These included potential adverse events like cytokine release syndrome and neurotoxicity, as well as differences in treatment durability and mortality risk. The study used a series of choice sets to determine how much weight patients placed on different outcomes.
“We found that while some patients consistently prioritized lower risks, especially upfront mortality risk, the majority were willing to accept some short-term risk in exchange for longer-lasting treatment benefits,” Reed said.
This approach allowed the team to quantify the maximum-acceptable risk patients would tolerate for a more durable response, potentially avoiding long-term side effects and maintenance therapy.
The findings have broad implications—not just for clinicians, but also for regulatory bodies like the FDA. Understanding population-level preferences helps inform approval decisions and clinical guidelines.
“As doctors, we’re supposed to be aligning treatment options with patient values and goals,” LeBlanc said. “Instead of shared decision-making we often default to more of an informed consent approach—presenting options without truly understanding what matters most to the patient.”
The study highlights the need for tools that help elicit patient preferences in a meaningful way. Rather than overwhelming patients with choices, the goal is to understand their values and use that information to guide discussions about treatment options.
DCI continues to be a leader in CAR T-cell therapy, offering access to some of the most advanced treatments available. As one of the largest CAR T centers in the Southeast, Duke University Health System provides both FDA-approved and clinical trial options, with experts helping to guide patients through these complex decisions.
The research team hopes to expand their work by designing and testing new preference elicitation tools that can be integrated into clinical practice. These tools aim to capture a patient’s “preference phenotype,” enabling clinicians to tailor treatment discussions more effectively.
“Patients often ask, ‘What would you do, doctor?’ because they don’t want to make the wrong decision,” Reed said. “Our goal is to support clinicians in making recommendations that truly reflect what’s most important to each patient.”
