With the approval of momelotinib by the FDA, the updated use for its role in myelofibrosis will potentially change clinical practice, according to Ruben Mesa, MD.
Prior to the approval of momelotinib, CancerNetwork spoke with Ruben Mesa, MD, to review how its use can change the standard of care for patients with myelofibrosis.1
Mesa, president of the Enterprise Cancer Service Line and senior vice president of Atrium Health, executive director of the National Cancer Institute–designated cancer center at Atrium Health Wake Forest Baptist Comprehensive Cancer Center, and vice dean for Cancer Programs at Wake Forest University School of Medicine in Winston-Salem, North Carolina, also highlighted other JAK inhibitors that are currently in use, one of which may overlap with momelotinib.
Results from the phase 2 MOMENTUM trial (NCT04173494) helped lead to the approval of momelotinib.2 The trial analyzed momelotinib vs danazol in patients with symptomatic and anemic myelofibrosis.
The median baseline total symptom score (TSS) was 28.0 in the momelotinib arm vs 25.7 in the danazol arm, with hemoglobin being 8.1 g/dL and 7.9 g/dL. Following treatment with momelotinib and danazol, respectively, the TSS at week 24 was 24.6% vs 9.2%. Additionally, 31% vs 20% of patients in each respective arm were transfusion independent at 24 weeks.
[Momelotinib] will make an immediate impact. There clearly are individuals now who are on JAK inhibitors [such as] ruxolitinib or fedratinib [Inrebic] that have significant anemia and will immediately be potential candidates. We’ll see how the National Comprehensive Cancer Network guidelines form, but there’s a case to be made for consideration [for the agent] as the initial JAK inhibitor selected for [patients who] have significant anemia. We’ll see what the label is.
There will be an overlap for a segment of patients or candidates for pacritinib [Vonjo]. Individuals with a platelet count of less than 25 mL who have only been tested with pacritinib [and had a platelet count of] 25 mL to 50 mL were also included in this trial. One might have a case for either agent. Patients who are anemic with a platelet count of 100 mL will be more clear candidates for momelotinib as the primary agent.