Dr Komrokji on the Implications of the COMMANDS Trial in MDS

Rami Komrokji, MD, vice chair, Malignant Hematology Department, head, the Leukemia and MDS Section, Moffitt Cancer Center, senior member, the Malignant Hematology and Experimental Therapeutics Program, professor in Medicine & Oncologic Sciences, the College of Medicine, the University of South Florida, discusses the clinical implications of the phase 3 COMMANDS trial (NCT03682536) in patients with very low–, low-, or intermediate-risk myelodysplastic syndromes (MDS) who have not received prior treatment with an erythropoiesis-stimulating agents (ESAs).

The trial evaluated the efficacy and safety of luspatercept-aamt (Reblozyl) vs ESAs for the treatment of anemia in this patient population. Data presented at the 2023 ASCO Annual Meeting showed that the study met its primary end point of red blood cell (RBC) transfusion independence. Findings showed that 58.5% of patients who received luspatercept achieved transfusion independence for at least 12 weeks with hemoglobin increase of at least 1.5 g/dL compared with 31.2% of patients who received epoetin alfa.

Luspatercept is currently under priority review by the FDA for the treatment of anemia in patients with very low– to intermediate-risk MDS who have not previously received ESAs and who may require RBC transfusions.

This trial aimed to evaluate luspatercept in the up-front setting, Komrokji says. The study evaluated the agent in those with ESA-naive, lower-risk MDS who requiredtransfusions, and they were randomly assigned to receive luspatercept or standard-of-care epoetin alfa.

Findings showed that benefits were observed in nearly all subsets of patients, Komrokji expands. Notably, in patients with an endogenous serum level between 200 and 500 U/L, luspatercept elicited at 12-week RBC transfusion independence rate of 41.5 vs 12.1% for ESAs, Komrokji explains. Overall, the COMMANDS trial is going to continue to move the field of treatment for patients with very low– to intermediate-risk MDS, leading to more durable responses, Komrokji concludes.