Terrence J. Bradley, MD, assistant professor, Department of Medicine, Sylvester Comprehensive Cancer Center, University of Miami Health System, discusses the utility of ruxolitinib (Jakafi) in myelofibrosis and polycythemia vera.

Ruxolitinib is the main treatment option in myelofibrosis and polycythemia vera. The agent received FDA approval for use in these patient populations based on data from the phase 3 COMFORT-II and RESPONSE trials, respectively, says Bradley. In myelofibrosis, the agent demonstrated improved overall survival (OS) versus both placebo and best available therapy at the 5-year mark. Ruxolitinib is also very effective as a second-line treament for patients with polycythemia vera; it has shown to have a very good response as far as reduction in spleen volume.

The OS in the studies might be underappreciated because crossover was permitted if patients were not responding on placebo or best available therapy; these patients were allowed to cross over to the study agent, explains Bradley. That which may narrow the gap in both progression-free survival and OS at these time points further out, concludes Bradley.

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Terrence J. Bradley, MD, discusses the utility of ruxolitinib (Jakafi) in myelofibrosis and polycythemia vera.

Dr. Bradley on the Utility of Ruxolitinib in Myelofibrosis and Polycythemia Vera

Terrence J. Bradley, MD, assistant professor, Department of Medicine, Sylvester Comprehensive Cancer Center, University of Miami Health System, discusses the challenges of treating patients with myeloproliferative neoplasms (MPNs).

Drugs are available for patients with MPNs, but not many therapies are approved, says Bradley. When patients do respond to these therapies, only a subset of these patients achieve durable responses. One of the challenges faced with this disease is that physicians are treating splenomegaly, which is increased spleen size, and blood counts. It is also very challenging because many of these secondary end points that are followed involve symptom burden, which is a subjective tool scored by patients; because it depends on how patients feel day to day, that may affect end points on a study, concludes Bradley.

Terrence J. Bradley, MD, discusses the challenges of treating patients with myeloproliferative neoplasms.
 
 

Dr. Bradley on the Challenges Faced in MPNs

Terrence J. Bradley, MD, assistant professor, Department of Medicine, Sylvester Comprehensive Cancer Center, University of Miami Health System, discusses the evolution of therapeutic strategies in myeloproliferative neoplasms (MPNs).

Interferon is used for a variety of malignancies, says Bradley; this is an injectable therapy that is effective, but not well tolerated. Patients with MPNs who receive interferon treatment often experience viral, flu-like symptoms, as well as depression, fever, and joint aches. Due to these symptoms, most patients cannot stay on that type of therapy for a prolonged period of time, adds Bradley.

The field of MPNs is going to shift to use of more oral and selective agents. More epigenetic targeted therapies will emerge in the future, predicts Bradley. Drugs, such as interferon, have already become an afterthought, according to Bradley; these agents are mainly used in patients who do not have any other options available or those who are pregnant because that is the only known safe therapy option. The field is going to see many new oral, active, selective, and safe agents forthcoming, concludes Bradley.

Terrence J. Bradley, MD, discusses the evolution of therapeutic strategies in myeloproliferative neoplasms.

Dr. Bradley on Evolving Therapeutic Strategies in MPNs

Terrence J. Bradley, MD, assistant professor, Department of Medicine, Sylvester Comprehensive Cancer Center, University of Miami Health System, discusses the use of ruxolitinib (Jakafi) in the treatment of patients with myeloproliferative neoplasms (MPNs).

Ruxolitinib is a JAK1/2 inhibitor that is approved by the FDA for the treatment of patients with myelofibrosis (MF) and polycythemia vera (PV). In MF, ruxolitinib has been shown to improve overall survival (OS) in comparison with placebo and best available therapy. In PV, ruxolitinib is indicated for use in the second-line setting for patients who have progressed on hydroxyurea. In PV, ruxolitinib has demonstrated a reduction the splenic volume in patients, thereby reducing their symptomatic burden, says Bradley.

Although the agent has yet to demonstrate an improvement in OS in PV, the rates of OS may be underestimated since crossover was allowed in the phase III COMFORT-I/II trial in MF as well as in the phase III RESPONSE trial in PV, concludes Bradley.

Terrence J. Bradley, MD, assistant professor, Department of Medicine, Sylvester Comprehensive Cancer Center, University of Miami in Health System, discusses the use of ruxolitinib (Jakafi) in the treatment of patients with myeloproliferative neoplasms (MPNs).

Terrence J. Bradley, MD

Articles

Dr. Bradley on the Utility of Ruxolitinib in Myelofibrosis and Polycythemia Vera

Dr. Bradley on the Challenges Faced in MPNs

Dr. Bradley on Evolving Therapeutic Strategies in MPNs

Dr. Bradley on Ruxolitinib in Myeloproliferative Neoplasms