HMAs Are ‘Cornerstone’ in High-Risk MDS Treatment, Says Jamile Shammo, MD

On this episode of “The HemOnc Pulse,” Dr. Shammo, a Professor of Medicine in Hematology and Oncology at Northwestern Medicine, discusses how to approach treatment for myelodysplastic syndromes (MDS), including treating patients with erythropoiesis stimulating agents (ESAs) or hypomethylating agents (HMAs).

“What treatments are out there for myelodyslplasia?” asked host Chadi Nabhan, MD, MBA, FACP.

“If you have someone with high-risk disease, their time to acute myeloid leukemia evolution and overall survival is much shorter,” Dr. Shammo responded. “Giving MDS-directed therapy, changing the biology of the disease, and considering transplantation is important.”

HMAs such as decitabine and cedazuridine (Inqovi) have become the “cornerstone” of treating high-risk patients, according to Dr. Shammo.

“That oral agent became possible because the cedazuridine inhibits cytidine deaminase, which would have metabolized the HMA in the gut. When you block it, now you’re able to use it orally,” she explained.

Next, Dr. Nabhan asked what patients should expect in terms of response when being treated with Inqovi for high-risk MDS.

“The clinical trial data that looked at Inqovi provided similar results—if not a little bit better—than decitabine,” Dr. Shammo said. “In general, I think you can expect 50%-60% improvement. Included in that is complete response, partial response, and hematological improvement.”

As for side effects, cytopenias are expected in the first two cycles of therapy, Dr. Shammo noted.

“You have to monitor the patient very closely in the first two cycles where there’s a risk of developing neutropenic fevers or need for transfusion,” she said. “After the first two cycles, you’ll start to see the platelet count improve.”