ESH MDS 2024 | Sequencing of agents in LR-MDS
Guillermo Garcia-Manero, MD, University of Texas MD Anderson Cancer Center, Houston, TX, briefly comments on combination therapies and the sequencing of therapies in the treatment of patients with lower-risk myelodysplastic syndromes (LR-MDS). Currently, combination approaches have not been studied in LR-MDS. Still, Prof. Garcia-Manero believes that this is the direction in which the field should go to further improve the response rates seen with currently approved agents. In terms of sequencing of agents, Prof. Garcia-Manero believes that community physicians should reconsider the standard approach of using erythropoiesis-stimulating agents (ESAs) in the frontline. Luspatercept, although more expensive, is associated with a high rate and durability of response and should, therefore, be utilized in this most favorable context. This interview took place at the European School of Hematology 9th Translational Research Conference on Myelodysplastic Syndromes (ESH MDS) in Budapest, Hungary.
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Transcript (edited for clarity)
There is no combination study, that I’m aware of, for lower-risk MDS, but I think that’s where the field should go because we’re seeing great responses with luspatercept and it would be good if we had a 100% response rate. So that’s something that is not really starting as of yet that I’m aware of, at least in the United States, but we need that...
There is no combination study, that I’m aware of, for lower-risk MDS, but I think that’s where the field should go because we’re seeing great responses with luspatercept and it would be good if we had a 100% response rate. So that’s something that is not really starting as of yet that I’m aware of, at least in the United States, but we need that. I think the question is, the sequencing is also very pertinent. This is more not from a clinical trial [point of view], this is more from a regulatory type of approach. And there are some schools of thought here where some physicians would like to use drugs like ESA in the first line because of cost and move to luspatercept in the second line. My view is the reverse. I think that luspatercept is very effective up front, and therefore, if you’re going to use your more expensive drug, you may want to use it in the best context, because frontline luspatercept is associated with a very high rate of response and also long durability of those responses. If you invert that, the response rate halves, and the duration of response also halves. But there’s quite a bit of debate about this. My feeling is that, as the community physicians, at the end of the day, these are actually in the United States community physicians, as they become more familiar with front line hematology drugs like luspatercept, they will see the benefit of using these drugs up front instead of ESAs that we have had for 30 years and they’re really mediocre compounds. But we’ll see.
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