ESAs-Only MDS Management: Does the Real-World Experience Differ from Clinical Trials?

In a series of roundtable discussions, an expert panel moderated by Jamile Shammo, MD, of Northwestern University, explored current issues in myelodysplastic syndromes (MDS) care. The panel included David Swoboda, MD, of Tampa General Hospital; Saeed Sadeghi, MD, of the David Geffen School of Medicine; and Christopher Benton, MD, of Rocky Mountain Cancer Centers.

The panel reacted to real-world data on erythropoiesis-stimulating agent (ESA)-only management of anemia in patients with lower-risk MDS. These data were gathered in a study conducted at a large community oncology practice in the US.

The panel noted the lack of a clear definition of patient response to ESA therapy. For Dr. Sadeghi, this raised a question of what is considered a response in real-world practice versus in the context of a clinical trial. Regarding consequences of this, “you start to wonder if maybe we have set ourselves and patients to accepting stable disease,” Dr. Shammo remarked.

Nevertheless, the panel regarded the study as bringing helpful real-world data. Noting that real-world patients starting ESA therapy differed in transfusion dependency and starting hemoglobin levels from cohorts in clinical trials, Dr. Swoboda said the study “really kind of shows what life looks like outside of academic practice.”

According to Dr. Benton, these data add clarity on how to sequence currently available and upcoming drugs, as well as when to switch from an ESA to luspatercept, in patients with lower-risk MDS.