MDS: Patient-Reported Outcomes and Imetelstat Toxicity in IMerge Phase 3 Trial

Opinion
Video

Dr Schiller reviews data updates from the IMerge phase 3 trial looking at patient-reported outcomes and cytopenias in patients with MDS following imetelstat treatment.

This is a video synopsis of a discussion featuring Gary J. Schiller, MD, chief of the Hematological Malignancy/Stem Cell Transplantation program at the David Geffen School of Medicine at UCLA Health Jonsson Comprehensive Cancer Center.

Gary J. Schiller, MD, discusses a presentation by Dr Sekeres that discussed quality of life data from the imetelstat IMerge trial comparing imetelstat to placebo. The Functional Assessment of Cancer Therapy-Anemia and MD Anderson Symptom Inventory-Myelodysplastic Syndrome questionnaires were administered.

A positive mean change in dyspnea score was observed through treatment cycle 24 with imetelstat but not placebo. The model estimated quality of life scores would significantly improve with imetelstat versus placebo. It is unclear if improvements were restricted to imetelstat responders with decreased transfusion dependence versus all patients.

Transfusion-dependent anemia in lower risk MDS is associated with symptoms like dyspnea, fatigue, and inflammation from the MDS clone. With very low response rates in the placebo arm, particularly in higher risk molecular subgroups, the significantly better responses with imetelstat should translate to quality of life improvements. Analyzing data based on transfusion independence response would have clarified this.

In another trial, investigators characterized the incidence and frequency of neutropenia and thrombocytopenia emergent adverse events with imetelstat. These were more common early, decreasing over time. About two-thirds of patients had neutropenia and thrombocytopenia in cycles 1-3, declining to 31% to 37% after cycle 13. Three grade 3/4 neutropenia patients had grade 3/4 infections. No grade 3/4 thrombocytopenia patients had severe bleeding and there were no cytopenia attributed deaths.

There is a signal of increased neutropenia/thrombocytopenia early with imetelstat treatment that decreases over time.

*Video synopsis is AI-generated and reviewed by Targeted Oncology editorial staff.

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