Expert Highlights Safety Profile of Oral Azacitidine in Lower-Risk MDS

Commentary
Video

Adverse effects associated with oral azacitidine in low- or intermediate-risk MDS are typically transient, according to Mikkael A. Sekeres, MD, MS.

Mikkael A. Sekeres, MD, MS, spoke with CancerNetwork® at the 2024 American Society of Clinical Oncology (ASCO) Annual Meeting about monitoring and managing toxicity in patients who receive oral azacitidine (Onureg) for low- or intermediate-risk myelodysplastic syndromes (MDS). He discussed the safety profile of the agent in the context of findings from the phase 2/3 ASTREON trial (NCT05469737), which assessed oral azacitidine plus best supportive care in patients with lower-risk MDS.

According to Sekeres, a professor of Medicine and chief of the Division of Hematology at Sylvester Comprehensive Cancer Center of the University of Miami Health System, most toxicity associated with oral azacitidine in the trial, including neutropenia and thrombocytopenia, were transient, as patient blood levels typically stabilized following these adverse effects. Additionally, any instances of nausea during treatment were mitigated with anti-nausea drugs.

Sekeres also described the potential next steps for researching orally available azacitidine in this patient population. Future research aims to replicate the responses reported in the initial ASTREON trial cohort across an expanded population of those with lower-risk MDS.

Transcript:

The next step in looking at oral azacitidine is to use it in an expanded patient population of those with lower-risk myelodysplastic syndromes and figure out if those response rates that we saw in this initial cohort of patients are replicated in a larger population. [We will] also look for any unusual [adverse] effects.

One of the most common adverse effects associated with any hypomethylating agent is that these drugs can make the blood counts worse before they make them better. Patients may develop neutropenia while taking these drugs, develop thrombocytopenia, and their anemia may not correct itself. Usually, these [adverse] effects are transient. Particularly, in those patients who respond to the drugs, they recover their blood counts. These drugs can also be associated with nausea. This has largely been entirely abrogated with the use of very effective anti-nausea medicines.

Reference

Garcia-Manero G, Yee KWL, Hernandez F, et al. Preliminary safety and efficacy of oral azacitidine (Oral-AZA) in patients (pts) with low-/Intermediate (Int)-risk myelodysplastic syndromes (MDS): phase 2 results from the ASTREON trial. J Clin Oncol. 2024;42(suppl 16):6509. doi:10.1200/JCO.2024.42.16_suppl.6509

Related Videos
Jorge E. Cortes, MD, emphasizes proper communication between patients with chronic myeloid leukemia and their providers during the treatment course.
Dietary interventions or other medications may help mitigate diarrhea in patients who undergo therapy for chronic myeloid leukemia.
Considering notable adverse effects associated with treatment may be critical when selecting therapy options for those with CML.
Whether CAR T-cell therapy or T-cell engagers should dominate the multiple myeloma landscape may be hard to determine, says David S. Siegel, MD.
Next steps for research in the multiple myeloma space may include the development of novel CAR T-cell strategies and bispecific antibodies.
Ongoing research may clarify the potential benefit of avelumab when administered in combination with other agents in advanced urothelial carcinoma.
Spatial analyses may help determine factors that influence responses to sacituzumab govitecan-containing regimens in urothelial carcinoma.
Attending educational sessions may help with understanding how to manage toxicities associated with enfortumab vedotin in rare genitourinary cancers.
Ongoing genomic profiling analyses in the ASC4FIRST trial may further determine which patients with CML may benefit from treatment with asciminib.
Byoung Chul Cho, MD, PhD, highlights ongoing trials assessing intravenous and subcutaneous amivantamab in EGFR-mutant non–small cell lung cancer.
Related Content