Luspatercept Continues to Improve Survival in Low-Risk MDS

In an interview with Targeted Oncology, Guillermo Garcia-Manero, chief of the Myelodysplastic Syndromes (MDS) Section, Department of Leukemia, at The University of Texas MD Anderson Cancer Center, discusses the phase 3 COMMANDS trial evaluating luspatercept (Reblozyl) in patients with low-risk MDS.

The COMMANDS trial is a phase 3 trial comparing luspatercept vs epoetin alfa. Luspatercept is a TGF-beta modulator that, in a prior study known as MEDALIST (NCT02631070), was shown to be active and safe in second-line transfusion-dependent patients with lower-risk MDS.

COMMANDS compares luspatercept with the standard of care erythropoietic-stimulating agent, epoetin alfa, in previously untreated transfusion-dependent patients with low-risk MDS of any type. The low risk is defined by IPSS-R as less than 3.5 points, according to Garcia-Manero.

The primary end point of the study was a dual end point of transfusion independence and an increase in hemoglobin of at least 1.5 grams.

"The study met its primary end point, and it has become probably the standard of care for a significant fraction of patients with low-risk MDS that are transfusion dependent. It's approved in many countries all over the world," says Garcia-Manero.

In an updated analysis of COMMANDS, luspatercept appears to maintain superiority in terms of limiting the rate of transfusions and improving the survival of patients with low-risk MDS.

"I think this is important because until now, most of the studies in low-risk MDS have focused [on] mitigating transfusions and maybe the complications of those transfusions. But here, for the first time, we are seeing a significant improvement in survival. And the question is: how does this happen? I think this is actually going to be transformative in this field," Garcia-Manero says.