Early vs Late Onset of ESA in LR-MDS: Results From Phase 3 EPO-PRETAR Trial

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EP: 1.Early vs Late Onset of ESA in LR-MDS: Results From Phase 3 EPO-PRETAR Trial

EP: 2.COMMANDS and ELEMENT-MDS Trials: Long-Term Analysis, Survival, Duration of Response, and Hemoglobin Levels

The video segment from Cancer Network^Ò’sFace-Off introduces a competitive educational program centered on lower-risk myelodysplastic syndromes (LR-MDS). The event is structured as a playful yet informative debate between 2 teams named after Chicago’s baseball rivals. It is designed to be more dynamic than standard presentations, featuring data reviews, formal debates on key treatment issues, and discussions of complex patient scenarios. The goal is to combine clinical insight with engaging dialogue to promote learning in a unique format.

The featured abstract discussed results from the phase 3 EPO-PRETAR trial, which evaluated early vs late initiation of erythropoiesis-stimulating agents (ESAs) in patients with LR-MDS and anemia. Patients were randomly assigned to receive ESA therapy either early—when hemoglobin was still relatively high—or later, once hemoglobin dropped closer to transfusion thresholds. Both groups received the same dosing regimen of 60,000 units weekly for 12 weeks. The primary end point was time to red blood cell transfusion dependence, with secondary end points including response rates and duration of transfusion independence.

The findings showed that while the time to transfusion dependence was similar in both arms, early ESA use resulted in significantly higher response rates and longer durations of transfusion independence. However, overall survival and progression-free survival were not significantly different. The opposing team raised valid concerns about the trial’s reliance on hemoglobin thresholds alone, without including patient-reported symptoms or quality-of-life metrics as eligibility or outcome criteria. They emphasized that hemoglobin levels may not fully reflect clinical well-being and called for future trials to integrate patient-centered end points for a more holistic assessment of benefit.