Treatment Approaches Become More Individualized as Field of Myelofibrosis Advances

Ruben Mesa, MD, director, Mays Cancer Center at The University of Texas Health San Antonio, MD Anderson Cancer Center San Antonio, TX, shares highlights from his presentation on the role of JAK inhibitors in myelofibrosis (MF) during the first annual Texas Virtual MPN Workshop and Meeting.

The key takeaway is to be incredibly hopeful for having such a robust set of therapies in development for the treatment of MF, many of which are active, credible treatments, Mesa says. Two years from now, we may have multiple approved agents that may have a variety of different pathways that might be individualized.

For patients with marked thrombocytopenia, you may give the patient pacritinib, or if they are transfusion-dependent, perhaps momelotinib upfront or ruxolitinib (Jakafi) and luspatercept (Reblozyl) or fedratinib (Inrebic) and luspatercept, Mesa adds. Patients with a certain high-risk mutation could start treatment with a JAK inhibitor and the BET inhibitor, or patients could be treated with ruxolitinib for 3 months and have a suboptimal response, so then they end up receiving venetoclax (Venclexta).

Mesa says treatment of MF will become more nuanced and much more individualized in time. He believes that the period of time a patient is on therapy before an evaluation will also change. In the future, we will likely have more concrete markers so that if patients do not achieve response in 3 or 6 months, physicians can try another therapeutic approach.