Category Archives: Clinical Trial

Efficacy of JAK1/2 inhibition in murine myeloproliferative neoplasms is not mediated by targeting oncogenic signaling

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May 24, 2025

Sivahari Prasad Gorantla, Michael Rassner, Kirstyn Anne Crossley,…Robert Zeiser & Justus Duyster

Abstract

Ruxolitinib is a potent JAK1/JAK2 inhibitor, approved for the treatment of primary myelofibrosis (PMF) patients based on the concept of inhibition of oncogenic signaling. However, the effect of ruxolitinib on JAK2-V617F allelic burden is modest, suggesting that inhibition of JAK2-V617F signaling-driven clone expansion is not the main mechanism of action. We evaluate whether ruxolitinib mainly blocks the proliferation of the malignant clone or exerts its effects also by targeting non-malignant cells. Therefore, we develop two JAK2-V617F-driven myeloproliferative neoplasm (MPN) mouse models harboring ruxolitinib resistance mutations. Mice carrying ruxolitinib-resistant JAK2-V617F-driven MPN respond to ruxolitinib treatment similar to mice with ruxolitinib-sensitive JAK2-V617F MPN with respect to reduction of spleen size, leukocyte count and pro-inflammatory cytokines in the serum. Ruxolitinib reduces pro-inflammatory cytokines in both stromal cells and non-malignant hematopoietic cells. Using a rigorous ruxolitinib resistance mutation approach, we can prove that ruxolitinib acts independent of oncogenic JAK2-V617F signaling and reduces the main features of MPN disease such as spleen size and leukocyte counts. Our findings characterize the mechanism of action for ruxolitinib in MPN.

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Evolving Myelofibrosis Treatments Aims to Fill Unmet Needs

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May 21, 2025

Author(s): Ryan Scott

Fact checked by: Spencer Feldman

Myelofibrosis is a Philadelphia-negative myeloproliferative neoplasms (MPN) and can occur as de novo disease. Myelofibrosis creates varying degrees of fibrosis and can cause driver mutations such as JAK2, CALR or MPL in approximately 90% of patients. These mutations cause constant activation of the JAK-STAT pathway, which can lead to uncontrolled cell growth.

Other mutations that can occur, such as ASXL1, SRSF2, EZH2, IDH1/2 and U2AF1, may also affect how the disease develops and prognosis. Moreover, common symptoms of the disease include fatigue, night sweats, fever, bone pain, cachexia, pruritus, thrombosis, and bleeding. Although disease progression is the most common reason for death and occurs in approximately 20% of patients, many patients also face serious risks from other complications. These include heart problems, infections, or bleeding due to low blood counts.

To combat the unmet needs within the myelofibrosis treatment landscape, there have been a number of studies investigating novel treatments for JAK inhibitor-ineligible or relapsed/refractory patients. To further explore these investigations, and the current and future states of the treatment landscapes, investigators broke everything down in research published in the American Journal of Hematology.

Understanding the Present Landscape and Ongoing Studies

The discovery of genetic mutations, as well as the role of the JAK-STAT pathway in the treatment of MPNs has led to the development of oral KAK inhibitors. These drugs work by blocking overactive JAK signaling involved in disease progression and symptom burden.

One such drug being used is Rituxan (ruxolitinib), which is the first ever U.S. Food and Drug Administration (FDA)-approved JAK inhibitor for myelofibrosis, approved by the regulatory agency in 2011. The agent elicits effective for symptom relief and spleen size reduction in approximately 50% of patients who are treated with it.

Common side effects of Rituxan include anemia and low platelets; other non-blood-related side effects include fatigue, diarrhea and infections. Long-term use of the agent may also increase the risk of secondary cancers (like non-melanoma skin cancer) and round 40% to 50% of individuals discontinue the drug within three years due to side effects or lack of efficacy. However, stopping Rituxan is linked to new mutations and poorer outcomes.

Another agent used in the treatment of myelofibrosis is Inrebic (fedratinib), which was approved in 2019 by the FDA for both patients with newly diagnosed disease and those who are refractory and/or intolerant to Rituxan. This agent provides similar benefits to those seen with Rituxan, including reduction of spleen size and symptoms, but with frequent gastrointestinal side effects, like nausea, diarrhea and vomiting.

Notably, Inrebic carries a black box warning for risk of Wernicke’s encephalopathy, making monitoring essential. Additionally, treatment with the agent is less effective in patients who were on high-dose Rituxan prior to switching.

Vonjo (pacritinib) is another treatment which was approved in 2022 for patients with severe low platelet counts in the myelofibrosis treatment space. Unlike Rituxan and Inrebic, it can be used in high-risk patients with more advanced disease and cytopenias. In trials such as the PERSIST-1 and PERSIST-2 studies, Vonjo showed modest spleen and symptom response but improved transfusion independence.

Vonjo is currently being tested in the PACIFICA trial for patients with platelets less than 50 × 10⁹/L.

Finally, Ojjaara (momelotinib) is also being used in the treatment space for patients with this disease and was approved by the FDA in 2023. Ojjaara targets JAK1/2 and ALK2, with a unique effect on anemia. Trials, including the SIMPLIFY-1 and SIMPLIFY-2 studies, showed similar spleen responses to Rituxan but greater improvements in anemia and transfusion independence.

The MOMENTUM study confirmed Ojjaara’s improved both symptoms and anemia in symptomatic, anemic patients previously treated with a JAK inhibitor.

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Ruxolitinib Plus Siremadlin Yielded Superior Spleen Volume Reduction in Patients With Myelofibrosis

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May 20, 2025

Author(s): Alexandra Gerlach, Associate Editor

Data from the ADORE trial (NCT04097821) suggest combining ruxolitinib (Jakafi; Incyte Corp) with novel agents such as siremadlin (HDM201, Novartis), rineterkib (LTT462; Novartis), sabatolimab (MBG453; Novartis), crizanlizumab (Adakveo; Novartis), or NIS793 (Novartis) was superior to ruxolitinib monotherapy in patients with myelofibrosis (MF). The investigators reported improved spleen volume reductions (SVR), which were greatest in patients treated with ruxolitinib in combination with siremadlin.1

3D visualization of red blood cells | Image Credit: © Thipphaphone – stock.adobe.com

MF is a disease that falls under the umbrella of myeloproliferative neoplasms, which is a group of diseases characterized by the overproduction of red blood cells, white blood cells, or platelets in the bone marrow. In MF, there is an ongoing reduced production of red blood cells that leads to bone marrow fibrosis, extramedullary hematopoiesis, recurrent splenomegaly, and anemia. Other symptoms can include fatigue, nocturnal sweats, bone pain, enlarged spleen, and weight loss. can arise as a main disease (primary MF) or as a subsequent condition to essential thrombocythemia (post-ET MF) and polycythemia vera (post-PV MF). In some cases, MF can progress to acute myeloid leukemia.2

Janus kinase (JAK) inhibitors, such as ruxolitinib, are the standard of care for treatment and management of MF-related complications and have yielded significantly favorable outcomes; however, they are associated with various adverse effects (AEs). Ruxolitinib was initially approved in 2011 for first-line treatment of patients with intermediate- and high-risk MF, but the agent is known to be highly associated with increased risk of persistent or worsening anemia. Despite its widespread use, approximately 70% of patients discontinue treatment after about 5 years, with a third citing an inadequate reduction in spleen volume as a key reason.3,4

ADORE is a randomized, open-label, phase 1/2 open platform study evaluating the safety and efficacy of 5 novel agents with ruxolitinib in patients with MF. The trial utilized an innovative open platform design and enrolled 44 patients in part 1 of the trial who were treated with ruxolitinib in combination with 1 of 5 investigational agents: siremadlin, rineterkib, sabatolimab, crizanlizumab, or NIS793. The largest cohort (n = 23) received the combination of ruxolitinib (orally at a dosage of 5 mg) and siremadlin (orally at a dosage of 10, 20, or 40 mg).1,4

Among those patients, the most common AEs were gastrointestinal issues, such as nausea and diarrhea, and hematologic toxicities, including thrombocytopenia, anemia, and neutropenia. Based on safety and efficacy findings, once-daily 30 mg siremadlin taken orally on days 1 through 5 of a 28-day cycle was chosen as the recommended phase 2 dose.4

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Real-World Data Shows Favorable Efficacy and Safety With Busulfan for MPNs

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Andrea S. Blevins Primeau, PhD, MBA
Publish Date

Busulfan treatment of myeloproliferative neoplasms (MPNs) demonstrated high response rates and infrequent adverse events (AEs), according to a study of real-world data from hospitals in the United Kingdom.

“Given the lack of prospective studies on the use of busulphan, our study contributes valuable real-world data on the safety and efficacy of busulphan which clinicians should find useful in managing this challenging cohort,” the researchers wrote in their report.

In the retrospective study, researchers analyzed data from 115 patients with MPNs from 13 hospitals. The median age of the cohort was 78 years and 44% of patients were male. The majority of patients had a diagnosis of essential thrombocythemia (ET) at 67%, followed by 24% with polycythemia vera (PV), 5% with MPN not otherwise specified, and 4% with myelofibrosis. JAK2 and CALR mutations were present among 62% and 13% of patients, respectively.

There were 16% of patients with a history of malignancy, including 8% of nonmelanoma skin cancers, and 8% with cancers that included those of the breast, prostate, lung, low-grade lymphoma, and melanoma.

One previous line of therapy (LOT) had been received by 13% of patients, 63% had 2 LOTs, 19% had 3 LOTs, and 5% had 4 LOTs. The most common previous cytoreductive therapy was hydroxycarbamide (78%), followed by anagrelide (16%), pegylated interferon (8%), P32 (3%), and ruxolitinib (2%).

The dosing regimens of busulfan included repeated single doses (31%) with a median dose of 38 mg, 1- to 4-week courses (30%) with a median dose 3.5 mg, and continuous therapy lasting more than 4 weeks (35%) with a median dose of 2 mg.

Our study contributes valuable real-world data on the safety and efficacy of busulphan which clinicians should find useful in managing this challenging cohort.

The median time from busulfan initiation to last follow-up or death was 23 months. There were 14% of patients who were alive with acceptable blood count control without any other cytoreductive therapy.

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MOMENTUM Trial Outcomes: Guiding Therapy for Myelofibrosis With Anemia and Splenomegaly

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By Pankit Vachhani, MD
Edward Pearson, MD
elists discuss how the MOMENTUM trial demonstrated momelotinib’s superiority over danazol in symptomatic anemic myelofibrosis patients, showing significant improvements in symptoms (the primary end point), meaningful spleen volume reduction (SVR25/SVR35), and anemia benefits, with experts noting that the inclusion of a washout period provided clearer evidence of momelotinib’s efficacy profile compared to the SIMPLIFY-2 trial.

Summary of MOMENTUM Trial: Momelotinib in Anemic, Symptomatic Myelofibrosis

Study Design and Population

  • Patient characteristics:
    • Required hemoglobin <10 g/dL
    • Symptomatic disease
    • Previously treated with Janus kinase (JAK) inhibitor therapy
  • Design elements:
    • Primary end point was symptom-driven
    • Active comparator arm (danazol) rather than placebo
    • Included a washout period (unlike SIMPLIFY-2)

Key Findings

  • Primary end point:
    • Momelotinib demonstrated superior symptom benefits compared to danazol
  • Secondary end points:
    • Multiple secondary end points met with superiority
    • Stronger spleen volume reduction data (SVR25, SVR35) than in SIMPLIFY-2
    • Confirmed anemia benefits

Clinical Implications

  • Comprehensive benefit profile:
    • Triple benefit: spleen reduction, symptom improvement, and anemia benefits
    • Washout period may have contributed to clearer demonstration of spleen benefits compared to SIMPLIFY-2
  • Clinician perspective:
    • Some practitioners noted less direct relevance of danazol comparison in their practice
    • Nevertheless, provided further evidence of momelotinib’s anemia benefit
    • Results support momelotinib use in patients with anemic, symptomatic myelofibrosis who have received prior JAK inhibitor therapy

The MOMENTUM trial reinforces momelotinib’s position in the treatment algorithm, particularly for patients with anemia who have been previously treated with other JAK inhibitors.

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Strategic JAK Inhibitor Sequencing: Translating SIMPLIFY I/II Outcomes to Optimize Myelofibrosis Management

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By Pankit Vachhani, MD
Edward Pearson, MD

Summary of Momelotinib Clinical Trials and Second-Line Applications

SIMPLIFY-1 (First-Line Setting)

  • Efficacy comparison with ruxolitinib in newly diagnosed myelofibrosis:
    • Spleen response: Momelotinib demonstrated spleen volume reduction
    • Symptom improvement: Not as robust as ruxolitinib
    • Anemia benefit: Preserved transfusion independence at week 24 vs baseline, while ruxolitinib showed slight decline
  • Clinical considerations for newly diagnosed myelofibrosis with moderate anemia:
    • Potential benefit of single-agent therapy (avoiding combination with erythropoiesis-stimulating agents)
    • When anemia contributes significantly to symptom burden, momelotinib may be preferable

SIMPLIFY-2 (Second-Line Setting)

  • Study design: Effectively a comparison of momelotinib vs ruxolitinib in previously treated patients
    • No washout period between treatments
  • Key outcomes:
    • Spleen response: Comparable between momelotinib and control (“a wash”)
    • Anemia: Clear advantage for momelotinib
    • Symptom control: Superior with momelotinib in the second-line setting
  • Expert opinion on optimal positioning:
    • Panel indicated greater preference for momelotinib in the second-line setting
    • Particularly valuable in patients with worsening anemia or diminishing spleen response on ruxolitinib
    • Setting appropriate expectations is crucial; emphasize anemia and symptom benefits rather than additional spleen reduction

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Clinical Trial Aims to Test Tagraxofusp and Pacritinib Combination Therapy in Patients With MF

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Özge Özkaya, MSc, PhD
Publish Date

A new study testing the combination of tagraxofusp and pacritinib in patients with myelofibrosis (MF) is now open.

The single-center, open-label, early phase 1, pilot trial aims to recruit 20 patients with MF who are at least 18 years of age and who have previously been treated with a Janus kinase (JAK) 1/2 inhibitor or in whom JAK1/2 inhibitor therapy is not appropriate, is contraindicated, or was declined.

Participants will be given 12 µg/kg of intravenous tagraxofusp once a day for 3 consecutive days and 200 mg of oral pacritinib twice a day starting at the 4th day of the second cycle and administered continuously with subsequent cycles starting on day 1 of each cycle.

The primary outcome measures will be a spleen volume reduction of 35% of more and the change in the Myeloproliferative Neoplasm Symptom Assessment Form Total Symptom Score Version 2.0 (MPN-SAF TSS 2.0) from baseline to week 24.

Secondary outcome measures will include the number of participants with treatment-related adverse events, the change from baseline in anemia and platelet count, and any improvement in patients’ quality of life based on the global impression of change.

Tagraxofusp is a cytotoxin directed at CD123, and pacritinib is a small-molecule kinase inhibitor. The rationale of using these 2 drugs in combination is their compatible mechanisms of action targeting MF stem cells and the bone marrow. It is thought that the combination may lead to improvements in symptoms associated with myeloproliferative neoplasms and reduce splenomegaly.

Both agents have previously been studied in cases of mildly depleted bone marrow and were shown to be safe and led to hematological improvements.

The trial is not yet recruiting participants but aims to recruit 20 participants. It is estimated to be completed in December 2026.

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Biomed Valley Discoveries Announces First Patient Dosed in Phase 1/2 Combination Study of Ulixertinib with Ruxolitinib (Jakafi®) in Patients with Myelofibrosis

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Provided by GlobeNewswire  

— Dual targeting of JAK 1/2 (ruxolitinib) and ERK 1/2 (ulixertinib) may represent a novel treatment approach for myelofibrosis and possibly other myeloproliferative neoplasms

KANSAS CITY, Mo., April 28, 2025 (GLOBE NEWSWIRE) — Biomed Valley Discoveries (BVD), a clinical-stage biotechnology company guided by its founders’ intent of bringing hope for life to patients, today announced that the first patient has been dosed in a Phase 1/2 combination study of ulixertinib, BVD’s highly selective, first-in-class ERK 1/2 inhibitor with ruxolitinib, a JAK1/JAK2 inhibitor for the treatment of myelofibrosis, a rare type of bone marrow cancer that disrupts the body’s normal production of blood cells.

Raajit Rampal, M.D., Ph.D., a hematologist-oncologist with Memorial Sloan Kettering Cancer Center who specializes in the treatment of myeloproliferative neoplasms and leukemia, is the lead principal investigator for this investigator-initiated trial.

“We’re thrilled to announce the milestone of first patient dosed in this trial, and grateful for the opportunity to collaborate with Dr. Rampal and Incyte to explore the potential of ERK inhibition as a complement to JAK inhibition for the treatment of patients with myelofibrosis,” said Brent Kreider, Ph.D., President of BVD. “This trial helps further our commitment to fully interrogate the potential of direct ERK inhibition to address unmet patient needs in various cancer settings where MAPK signaling is implicated.”

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Fatigue, Quality of Life Improve With Rusfertide: Andrew Kuykendall, MD

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April 27, 2025

Author(s): Maggie L. Shaw, Andrew Kuykendall, MD

Bringing this interview with Andrew Kuykendall, MD, clinical researcher at Moffitt Cancer Center, to a close, he addresses safety concerns that have been linked to the injectable hepcidin mimetic rusfertide (Takeda) and its overall impact on patient quality of life. Rusfertide is under investigation for treatment of polycythemia vera, a myeloproliferative neoplasm, in the ongoing phase 3 VERIFY trial (NCT05210790), on which Kuykendall is an investigator.

Previous segments of this interview focused on managing polycythemia vera, understanding hematocrit thresholds, reducing thrombotic risk, and reducing patient dependence on phlebotomy.

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Clinical Trials Can Open Doors for Patients With Myeloproliferative Neoplasms

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By Kathryn Johnson, DNP, MSc, FNP-BC
Fact checked by Bridget Hoyt

Educating patients on the “risks and benefits” of clinical trials is a part of the pipeline for better treatment options in myeloproliferative neoplasms (MPNs) in which nurses can engage, said a nurse practitioner.

For patients with MPNs, clinical trials have paved the way for better treatment outcomes, increasing options vastly within a short amount of time. In an interview with Oncology Nursing News, Kathryn Johnson, DNP, MSc, FNP-BC, spoke to the importance of the development of these options and nurses’ role in making those possible.

As Johnson, a clinical program manager at Icahn School of Medicine at Mount Sinai New York, outlined, nurses can play a key part in informing patients on what to expect on clinical trials. She advised not only being prepared with information patients should know, but making time for patients to air their concerns and ask questions as well.

Johnson added that in the time that she has been working in oncology, multiple advancements have been made in the treatment of MPNs. She expects this trend to continue in the coming years.

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