Aditi Shastri, MD: Clinicians Need to ‘Come Together’ on TP53-Mutated MDS
Jan 18, 2024
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Dr. Aditi Shastri, Assistant Professor of Medicine at Montefiore Einstein Comprehensive Cancer Center, discusses TP53-mutated MDS, treatment options, risk stratification tools, emerging drugs like IMETEL stat and sabatolimab, and the decision-making process of observing versus intervening in patients with MDS.
Understanding the risk and prognosis associated with TP53 mutations is crucial for therapeutic decision-making in myelodysplastic syndrome (MDS).
Luspatercept has shown positive results in treating anemia associated with low-risk MDS, with faster anemia response, transfusion independence, and sustained response compared to epoetin alpha.
Deep dives
Insights into TP53 Mutations in MDS Patients
One of the main highlights of the podcast episode is the discussion on the impact of TP53 mutations in patients with myelodysplastic syndrome (MDS). The speaker emphasizes that understanding the risk and prognosis associated with TP53 mutations is crucial for therapeutic decision-making. The podcast mentions a study from the validate database, which reveals that patients with TP53 mutations, whether monoallelic or biallelic, have a worse prognosis compared to TP53 wild-type patients. This finding emphasizes the urgent need for better therapies for patients with complex karyotype, TP53 mutations, and MDS.
Efficacy of Luspatercept in Low-Risk MDS
The podcast also discusses the positive results of the IMERGE trial, which evaluated the use of luspatercept in treating anemia associated with low-risk MDS. The study showed that patients treated with luspatercept had a faster anemia response, transfusion independence, and sustained response compared to those treated with epoetin alpha. This finding has significant clinical implications as luspatercept has now moved into the frontline for treating anemia in low-risk MDS.
Promising New Drugs and Observation in MDS
The speaker highlights several promising drugs on the horizon for MDS treatment. These include IMETELstat, a telomerase inhibitor, and sabatolimab, an immune immunotherapy drug targeting the TIM3 pathway. Additionally, drugs inhibiting XPO1 and BCL2 are also being explored. The podcast also touches on the topic of observation in MDS management, stating that assessing the patient's clinical parameters, risk stratification, and mutation profile can help determine whether observation or intervention is appropriate. The speaker emphasizes that patient selection and individualized decision-making play a vital role in deciding whether to wait or initiate treatment.
This episode features a conversation between Dr. Shastri, an Assistant Professor of Medicine at the Montefiore Einstein Comprehensive Cancer Center in the Bronx, New York, and The HemOnc Pulse host, Chadi Nabhan; MD; MBA; FACP; on the latest news in myelodysplastic syndromes (MDS), including the final readout from the COMMANDS trial and the clinical implications of TP53-mutated MDS.
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