Mesa Discusses Highlights for the Treatment of Myelofibrosis in 2021

At ASH 2021, CancerNetwork® spoke with Ruben Mesa, MD, of UT Health San Antonio MD Anderson Cancer Center, about what changes in the treatment of myelofibrosis stood out to him most.

This year, I’d say the key was really having a much better sense of the JAK2 inhibitor therapies and how they might fit together. First, we had longer term follow-up in terms of fedratinib [Inrebic]. [There was] a signal of an improvement in survival in the frontline setting, and probably improvement in survival in the second line setting, and a better understanding of safety and efficacy. This is FDA approved, but further validation of the depth of benefit [was] seen with that important JAK2 inhibitor.

We saw further updates from real-world evidence that the survival benefit that we have seen and observed with ruxolitinib [Jakafi] appears very real no matter how we how we look at it. We looked at momelotinib [GS-0387] and I presented data earlier this year that showed an improvement in survival. That improvement in survival seemed to be correlated with the achievement of transfusion independence. [That is a] very interesting observation; is that [benefit] by the impact of the drug, is that the mere fact of becoming transfusion independent, or is it some of both?

Finally, we saw safety and efficacy with pacritinib [SB1518] that now looks like it will lead hopefully to an approval for that therapy. We’ve gotten much more detail for different JAK2 inhibitors. Survival advantage is probably present with at least 3 of [these agents], and likely as the data matures, with all 4. This suggests to me that they will remain a bedrock of therapy for myelofibrosis alone or in combination between those 4 drugs.