Hematologic Oncology Update, Issue 1, 2016 (Video Program)Schedule of demethylating agents and use of lenalidomide for myelodysplastic syndromes
1:57 minutes.
TRANSCRIPTION:
DR SMITH: The data that we have, the best data we have, is 7 days in a row. So it’s tough to look at it and say, “Hey. Do something different.” That being said, I want to get a response, because I know that these drugs aren’t likely to work long term for patients, particularly high-risk patients. But I want to get a response. And I think that you can trust 5 days of demethylating drugs — 5, 2 days off, 2 days on of these drugs or 7 days in a row to give you some data about response, because we know that patients can respond to any of those schedules. And many community physicians who really have good practices have developed ways to give these drugs successfully. DR LOVE: What about lenalidomide in MDS and particularly non-del(5q)? DR SMITH: Patients with non-del(5q) MDS, lenalidomide has been studied. And it’s actually pretty effective. Now, you have to weigh it, to balance it. So if I took a low-risk patient, primarily anemic, and said they need some transfusions once a month or once every 3 weeks and I want to get rid of that, lenalidomide is a pretty good drug. About 25% or 30% of patients will have improvement of their hemoglobin and become transfusion independent on lenalidomide. Now, that sounds pretty good. It’s a pill you take at home. It’s relatively well tolerated. You have to be very careful of other cytopenias, but patients can manage the drug. So lenalidomide, I think, is a good drug, worth considering in low-risk patients. Primarily, anemia is the problem. And whether or not they have the del(5q) or not, I think it’s a reasonable drug to use, because if you’re careful with it and it’s well tolerated by your patient, they can give the drug to themselves at home and manage it pretty well. |