Patient Characteristics Guide Decision Making for JAK Inhibitors in Myelofibrosis

Several patient characteristics — spleen size, symptom burden and blood counts, among others — are taken into consideration when deciding upon the best JAK inhibitor to treat myelofibrosis, a type of myeloproliferative neoplasm (MPN).

Dr. Prithviraj Bose, professor in the department of leukemia at The University of Texas MD Anderson Cancer Center in Houston, spoke with CURE onsite at the Society of Hematologic Oncology 2024 Annual Meeting, to discuss these factors to potentially optimize selection of the available JAK inhibitors for patients with myelofibrosis.

Transcript:

There is a lot of different patient characteristics one looks at. So, one looks at the size of the spleen, one looks at the burden of symptoms, and one looks at the blood counts. So, this is a unique cancer where treatment is not by … stage of the cancer, or, it's not very algorithmic in terms of what is front line, what is second line, what is third line. So it's really based on the need of the patient.

Now, again, generally, I will say of the four [Food and Drug Administration-]approved JAK inhibitors — again, JAK inhibitors are all we have approved in myelofibrosis — I think ruxolitinib (Jakafi), fedratinib (Inrebic), pacritinib (Vonjo) and momelotinib (Ojjaara), can all be used in frontline [setting], but I think what really happens is that it's either ruxolitinib or momelotinib, with momelotinib being favored if the patient is anemic, and otherwise ruxolitinib. I will say the majority [of patients] get ruxolitinib because it is so good for spleen and symptoms, and it has a survival benefit that's been shown [in clinical data].

In the second line, I think it goes back more to what I was saying about the clinical presentation. If you have good counts, large spleen, by all means, go with fedratinib. If you have, anemia, predominant presentation where that's what you're trying to improve the most, momelotinib, I think, is your best choice. If the platelets are super low, which is rare to happen in [the] front line [setting], much more common in second and later lines, if it less than 50 [platelets per microliter of blood], absolutely pacritinib. That has the best data, and it has good efficacy there. So I think … you cannot set exact rules, but these are just some pointers.

For more news on cancer updates, research and education, don’t forget to subscribe to CURE®’s newsletters here.