Jing Ai, MD, physician, Levine Cancer Institute, discusses the use of hypomethylating agents in patients with myelodysplastic syndrome (MDS).

The go-to regimen for patients with MDS is still hypomethylating agents, says Ai. There have not been any other recent approvals for this patient population that would replace these agents. Hypomethylating agents are used as a backbone, and a lot of clinical trials are building upon that backbone by adding targeted therapies, monoclonal antibodies, or immune-based therapies.

Levine Cancer Institute recently opened a clinical trial investigating a hypomethylating agent in combination with a PD-1 inhibitor in high-risk patients in the relapsed/refractory setting. In the field, there are different combinations such as IDH1/2 inhibitors and BCL-2 inhibitors. There are single-agent trials, states Ai, but most of them have the hypomethylating backbone.

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Dr. Ai on the Use of Hypomethylating Agents in Patients With MDS

Jing Ai, MD, physician, Levine Cancer Institute, discusses the rationale behind single-agent therapy and the development of combination therapy in patients with myelodysplastic syndrome (MDS).

Ai says that choosing between single agent and combination therapy usually depends on the experience of the treating physician. Single agents are often used in the relapsed/refractory setting, as these patients have already failed 2 or 3 lines of therapy. Physicians turn to whatever has the best biological reason for use, Ai says.

From a clinical trial standpoint, MDS as compared with acute myeloid leukemia (AML) does not receive as much attention, even though the 2 diseases are biologically similar, Ai says. Her hope is that clinical trials for AML extend to patients with MDS to improve upon available treatment.

Jing Ai, MD

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