Dr Jurcic on the Use of JAK Inhibitors in Myelofibrosis Management

Joseph G. Jurcic, MD, professor, of mMedicine at, Columbia University Medical Center; and dDirector, of the Hematologic Malignancies Section, of the Division of Hematology/Oncology, Columbia University Herbert Irving Comprehensive Cancer Center, discusses emphasizes the role of Janus kinase (JAK) inhibitors in the management of myelofibrosis, as well as as an essential consideration for oncologists navigating treatment pathways. Specifically, he commented on the nuanced selection criteria for variousof JAK inhibitors based on patient characteristics and disease progression.

JAK inhibitors are an integral part of management strategies in Jurcic advocated for the utilization ofruxolitinib as the primary therapeutic agent in patients presenting with myelofibrosis, Jurcic begins.He recommends ruxolitinib (Jakafi) for. This recommendation is particularly pertinent the treatment of patients for individuals with relatively preserved blood counts but who manifest distressing symptoms and substantial splenomegaly. Ruxolitinib's efficacy in alleviating symptoms and reducing spleen size underscores its status as the cornerstone of therapy in this patient population.

However, the landscape of myelofibrosis management extends beyond initial treatment choices, as patients who experiencedisease progressionandtreatment tolerability or intolerable toxicities duringinitial treatment will require necessitate alternative regimens, Jurcic continuesstrategies. Jurcic He notes that the selective oral JAK2 and FLT3 inhibitor fedratinib (Inrebic) has emerged as a viable option for patients who exhibit disease progression despite on prior ruxolitinib therapy. By targeting JAK2 and FLT3, fedratinib offers a therapeutic avenue for individuals experiencing refractory disease, enriching the armamentarium of oncologists managing myelofibrosis.

Moreover, the consideration ofadverse effects such as thrombocytopenia and anemia further complicates treatment decision-makings in myelofibrosis, Jurcic adds. The unique mechanism of action and potency of pacritinib (Vonjo) can be leveraged for Jurcic highlights the utility of procritinib in patients with significant thrombocytopenia, leveraging its potential to mitigate both thrombocytopenia and/or myelofibrosis-associated anemia in the second line, he explains. Additionally, the JAK1/JAK2 and ACVR1 inhibitor momelotinib (Ojjara) is a standard treatment for adult patients with intermediate or high-risk myelofibrosis with anemia after its 2023 FDA approval for this indication, Jurcic says. This nuanced approach underscores the importance of tailoring treatment strategies to address multifaceted disease manifestationstoxicity concerns, optimizing patient’ outcomes and quality of life.

Additionally, tThe management of myelofibrosis extends beyond symptom control, and curative therapy may be considered forl, younger with a subset of patients with favorable fitness andharboring higher-risk disease, Jurcic states necessitating consideration of curative modalities. Jurcic He notes that transplantation ias currently the sole only curative intervention in the myelofibrosis armamentarium, particularly in younger patients with favorable fitness profiles and elevated disease risk.. This assertion underscores the imperative of prognostic stratification and personalized treatment planning in myelofibrosis, integrating transplant as a potentially curative option in select patient cohorts.

Jurcic's insights underscore the Overall, understanding the multifaceted nature of myelofibrosis management and considering , emphasizing the nuanced whether patients would benefit most from symptom control, disease modification, or curative interventions can help inform JAK inhibitor selection and selection of JAK inhibitors based on individual patient characteristics and disease progression. By delineating treatment strategies that encompass symptom control, disease modification, and curative interventions, oncologists can optimize therapeutic outcomes and enhance patient-centric care in the management offer patients with myelofibrosis.