How Is Luspatercept Being Used in Lower-Risk MDS Management?

A roundtable discussion, moderated by Amer Zeidan, MBBS, MHS, of Yale University, focused on the latest updates in the care of myelodysplastic syndromes (MDS). The panel included David Swoboda, MD, of Tampa General Hospital; Jamie Koprivnikar, MD, of Hackensack University Medical Center; and Sangeetha Venugopal, MD, MS, of the Sylvester Comprehensive Cancer Center in Miami.

In this segment of the series, the panel discussed how the approval of luspatercept has affected their frontline treatment of lower-risk MDS.

Dr. Zeidan: Jamie, for your practice, the drug luspatercept has now been approved in the frontline setting in August or September 2023. Has your practice changed in the frontline setting, and how do you think about using erythropoiesis-stimulating agents versus luspatercept versus lenalidomide in the frontline management of anemia and lower-risk MDS?

Dr. Koprivnikar: I think, absolutely, the data from the COMMANDS trial is practice-changing. Of course, for patients who are suffering from transfusion-dependent anemia, who have 5q minus lower-risk MDS, I’m still going to use lenalidomide in that particular group of patients. They were, after all, excluded from participation on COMMANDS. We really do not necessarily have the data to support the use of luspatercept in that subset of patients.

Otherwise, if I have a patient who would have been eligible for the COMMANDS trial, meaning erythropoietin (EPO) level less than 500, certainly I’m starting those individuals off with luspatercept.

I do think, in addition to the nearly double the response rate as compared to weekly epoetin alfa and the longer duration of response, epoetin alfa was dosed weekly as part of COMMANDS, whereas luspatercept was dosed every three weeks. And so, I find it very difficult and burdensome for my patients to come into clinic every week. So, to be able to offer them an every-three-week option I think just adds to their quality of life.

Now, I think the population of patients who we still don’t know what to do for are those who present with an EPO level of greater than 500. I don’t think we have any great options for those patients that are currently available to us, although I do think we’re going to be seeing the approval of some agents shortly that may be appropriate for that group of patients with an EPO greater than 500.