Gary J. Schiller, MD, concludes with thoughts on the clinical implications of recent data presented at ASH 2023 on the myelodysplastic syndrome treatment landscape.
This is a video synopsis of a discussion featuring Gary J. Schiller, MD, chief of the Hematological Malignancy/Stem Cell Transplantation program at the David Geffen School of Medicine at UCLA Health Jonsson Comprehensive Cancer Center.
Based on ASH presentations and literature, luspatercept offers advantages over erythropoiesis-stimulating agents (ESAs) for lower risk, transfusion-dependent MDS and symptomatic anemia, with higher response rates. For ESA-refractory patients, the telomerase inhibitor imetelstat induces transfusion independence in a minority but significantly more than placebo. This correlates with improved symptoms per quality-of-life scores.
However, it is unclear if imetelstat improves symptoms without directly alleviating anemia. Since inflammatory biomarker data from the phase 3 IMerge trial was not presented, effects attributable to decreased inflammation are speculative.
Early trials targeting the inflammasome to reduce inflammation integral to MDS and impaired erythropoiesis show promise. The anti-inflammatory agent canakinumab decreased a biomarker of inflammation but clinical responses are not yet seen. Further inflammation-directed trials are awaited to determine if targeting this pathway can improve anemia and related symptoms in lower risk MDS.
*Video synopsis is AI-generated and reviewed by Targeted Oncology editorial staff.
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