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Vijendra Singh: Why I’m skeptical about Imetelstat’s use for MDS treatment
Jun 11, 2024, 03:04

Vijendra Singh: Why I’m skeptical about Imetelstat’s use for MDS treatment

Vijendra Singh, Medical oncologist at Karmanos cancer center, shared a post on X/Twitter:

”Why I’m skeptical about Imetelstat’s use for MDS treatment: Imetelstat is an oligonucleotide that inhibits telomerase activity by binding to the RNA template of telomerase.

Clinical trial: IMerge trial studied low or Int-1 risk MDS patients with anemia, who are refractory or ineligible to ESA and have greater than 4 PRBC transfusions over an 8-week period.

Dosing: Administered as a 2-hour infusion every 4 weeks.

Primary endpoint: 8 -week transfusion independence (TI):

  • Imetelstat: 40%,
  • Placebo: 15%.

Secondary and exploratory endpoints:

  • 24-week TI: 28% vs. 3%,
  • 1-year TI: 18% vs. 2%.

Molecular response signal observed with Imetelstat.

Only 7 patients had prior luspatercept exposure, none achieved 8-week TI with Imetelstat.

No improvement in patient-reported anemia symptoms or fatigue.

Side Effects:

  • Grade 3-4 Neutropenia: 73% vs. 8%,
  • G-CSF use: 36% vs. 3%,
  • Infections: 47% vs. 34%,
  • Sepsis: 4.2% vs. 0%.

More Side Effects:

  • Grade 3-4 Thrombocytopenia: 65% vs. 8%,
  • Platelet transfusion requirements: 18% vs. 2%,
  • Bleeding: 22% vs. 12%.

Cytopenias had no correlation with erythropoietic response.

Other adverse effects:

  • Fatigue: 29% vs. 22%,
  • Myalgia/Arthralgia: 25% vs. 19%,
  • Headache: 13% vs. 5%,
  • Syncope: 6% vs. 1.7%,
  • Pruritis: 6% vs. 1.7%,
  • Fractures: 5% vs. 1.7%.

Does not seem this much toxicity is worth for such a marginal benefit, awaiting for some better dose response exploratory studies. Source.”

Source: Vijendra Singh/X