Comparing Imetelstat With Other Treatments in Low-Risk MDS

Amer Zeidan, MBBS, associate professor at Yale School of Medicine, discusses how imetelstat compares with other treatments for patients with lower-risk myelodysplastic syndromes (MDS) with anemia who are transfusion-dependent and ineligible for erythropoiesis stimulating agents (ESA).

Specifically, he discusses the approval of luspatercept-aamt (Reblozyl) based on findings from the phase 3 COMMANDS study (NCT03682536) and how it compares with what was seen in the IMerge/MDS3001 study (NCT02598661).

Transcription:

0:09 | The lower-risk MDS landscape has seen the approval of another important drug, which is luspatercept. Luspatercept initially was approved in the refractory/relapsed setting after ESA failure in our lower-risk, anemic patients with MDS, but the initial approval in that setting was among patients who are ring sideroblast-positive, then subsequently based on the COMMANDS trial, the approval was extended to the frontline setting, regardless of having ring sideroblast or not, because the COMMANDS trial showed that luspatercept led to significant increase in transfusion independence in patients against ESA. Based on this, the FDA extended the indication.

0:56 | I think there is still a significant need in the second-line setting, especially in patients without ring sideroblast and ring sideroblast unmutated MDS. Another important advantage of imetelstat is that it is very active even in heavily transfusion dependent patients. The median transfusion burden in patients in IMerge was 6 units per 8 weeks. [This is] quite heavy, almost an entire blood every week, while in the COMMANDS trial, generally, the median transfusion burden at baseline was around 3 units. I think for patients who are very heavily transfusion-dependent, patients who are ring sideroblast- negative after ESA is a failure, in both of those areas, I think imetelstat could fulfill an unmet need, especially when we know that a patient with lower-risk MDS will progress from 1 medication to the next and transfusion dependency is associated with significant comorbidities. Therefore, trying to make the patient transfusion dependent is very important.