Hematologic Oncology Update, Issue 3, 2016 (Video Program) - Video 21Activity of ruxolitinib in myeloproliferative neoplasms and therapeutic options for patients who experience a response followed by disease progression
2:23 minutes.
TRANSCRIPTION:
DR TIBES: JAK2 inhibitors are approved for myelofibrosis based on their symptom control as well as now in the second-line setting after hydroxyurea failure or intolerance for PV patients. So the way I use JAK inhibitors is for intermediate and high-risk patients, if they are symptomatic according to the DIPSS or DIPSS Plus Prognostic Scoring System. Those are scoring systems that essentially take several factors into account, both the risk score — so similar to the IPSS for MDS. But I let myself also guide mostly along the lines of does the patient have symptoms. Does the patient have cachexia, or does he have splenomegaly? Does he have weight loss, night sweats and so forth? So JAK2 inhibitors are very good at controlling symptoms in MPNs. They do also control the leukocytosis as well as erythrocytosis. So increased counts they can control as well. So if a patient has intermediate or higher-risk myelofibrosis, is symptomatic, I would start a patient on a JAK2 inhibitor. Currently, ruxolitinib is approved. DR LOVE: What about patients who, say, respond to ruxolitinib but then have symptomatic progression? Do other JAK inhibitors work? Are there other agents you can use? DR TIBES: Yes. So there are several agents that are in clinical trials after ruxolitinib progression. So upon ruxolitinib progression, first of all I always see what dose is the patient on. Is there still some room to increase the dose of ruxolitinib? If this has been maximized and if it’s clear progression, I do want to know if there’s a progression into a more accelerated phase of the myelofibrosis or even into blast phase, because that may change my approach. If a patient is young, has a true acceleration and progression of the disease or younger, at that point we would send him for evaluation for an allogeneic stem cell transplantation, although transplants are difficult in myelofibrosis patients. |