Mesa Discusses Recommendations for Clinical Trial Enrollment in Myelofibrosis

At ASH 2021, CancerNetwork® spoke with Ruben Mesa, MD, of UT Health San Antonio MD Anderson Cancer Center, about recommendations to healthcare providers about enrolling their patients into clinical trials for myelofibrosis.

The key takeaway for healthcare providers watching this is that this is an era of an unprecedented number of clinical trials for patients with myelofibrosis. If you have a patient with myelofibrosis, consider whether a trial might be an option. First, we have trials in JAK2 inhibitor–naïve patients and this is clearly a change from before. Frequently, I’ll have colleagues who will send me patients with myelofibrosis to visit. But after they’ve started on ruxolitinib [Jakafi], that might make them ineligible for these JAK2 inhibitor naïve studies. Touch base with your colleagues nearby who are doing myelofibrosis studies for those upfront studies in which there are several.

Secondly, there are studies for individuals who are having a suboptimal response. In the past, we really waited until somebody had completely failed due to intolerance or resistance of ruxolitinib. Now, it’s much more subtle. You have [patients on ruxolitinib for] 3 months or 6 months. If it really hasn’t achieved a perfect response, there’s likely a trial out there for them.

Finally, if they have truly failed ruxolitinib, they may have options available to them. Fedratinib [Inrebic] is available to be prescribed as second-line [therapy]. If you’ve not had a chance to use it yet, consider that. Pacritinib [SB1518] likely will be approved soon. If [you have a] patient who has cytopenic myelofibrosis; thrombocytopenia; potentially anemia; platelet that are under 100,000/μl, especially if it’s under 50 μl; then you’ll be considering pacritinib. There are many trials out there. Definitely be aware, there is likely a trial for your patient unless they’re on ruxolitinib and have been on ruxolitinib and are doing beautifully. For those patients, we likely will still have them remain on therapy just as is. But if anything is really suboptima, or if they’re JAK inhibitor naïve, there may be a trial.