Clinical Management of Patients with Lower-risk MDS

Transcript:

Hetty Carraway, MD: Let’s talk about the management of our patients with low-risk MDS [myelodysplastic syndromes]. What might the future look like? If it was approved in the upfront setting, you could choose luspatercept [Reblozyl] or ESA [erythropoiesis-stimulating agent]-based therapy. How might you approach that with your patients in the future?

Ralph Boccia, MD, FACP: The first thing we do is sit down with a patient, talk about the drugs themselves, the cost of the drugs themselves, the dosing—meaning schedules and everything else. The potential adverse event effects and events for both of the drugs. Then, you make a decision jointly. It is very important today to have that conversation with patients in all aspects of the therapies that we offer. And this one in particular because there’s a new therapy that is soon to be available.

What excites me is the notion that as we bring new drugs closer to frontline therapies, what’s the next step? The next step might be pre-transfusion-dependent patients. The majority of the patients that we see with low-grade MDS are not transfusion-dependent when they walk through the door, but they are symptomatic. Using some of these newer therapies before the patient actually needs a transfusion and subs potentially switching from the old ESAs in that population of patients is an exciting idea. That, plus the knowledge of whether or not in a transfusion-dependent ring sideroblasts-negative patient, whether the luspatercept therapy is better than ESA therapy. Unfortunately, the data is way too immature. We don’t have enough patients to know that, but there is at least some possibilities based on the data that that might be the case.

Hetty Carraway, MD: Can we bring some of these therapies earlier for patients and can that really impact the evolution of their disease and impact their quality of life? One of the challenges in this space is that previously patients were on or have been on ESA-based therapy and were often reluctant to take something away. How much of a challenge has that been for you?

Ralph Boccia, MD, FACP: I ask myself that same question every time. I typically will leave the patient on the ESA fearing that if I stop it, they will have more transfusion burden before they actually have the onset of action of the luspatercept.

Hetty Carraway, MD: A lot of practices that do that same behavior. Every time we wonder if the therapies are actually helping or causing harm. Our patient populations are often older patients that have drug-drug interactions and/or trouble with hypertension. With regard to their medical history, that would be reasons for us to stop a therapy like ESA-based therapy if we think it’s not helping. If I am not convinced it’s helping them, I will stop it. We worry about stopping medicines, but if we have other options for patients, I think it’ll be interesting to see how some of the practices may change with regard to some of those behaviors.

Ralph Boccia, MD, FACP: It’s called clinical judgment, right?

Hetty Carraway, MD: Exactly. I think the landscape for our patients with lower-risk MDS has really got a lot of promise. I’m looking forward to what emerges in the coming months to see the final outcome of this study and kind of the overall analysis and how it impacts our practice.

Transcript edited for clarity.