October 8, 2024
Author(s): Ashling Wahner
Fact checked by: Courtney Flaherty
The wealth of JAK inhibitors available for managing myelofibrosis invites the development of increasingly personalized treatment plans based on individual patient needs and disease characteristics, according to Idoroenyi Amanam, MD.
“We’ve come a long way since ruxolitinib [Jakafi] was FDA approved,” Amanam said in an interview with OncLive®. “We have a better understanding of which patients benefit from JAK inhibitors, and we are clearer on the shortcomings of JAK inhibitors.”
In the interview, Amanam discussed how JAK inhibitors measure up against other available therapies in myelofibrosis; patient characteristics that are most likely to indicate benefit with JAK inhibitors; and which of these agents he is likely to choose based on patients’ platelet counts, symptom burden, and treatment history.
For instance, Amanam highlighted the importance of pacritinib (Vonjo) in the myelofibrosis treatment paradigm. Pacritinib was approved by the FDA in 2022 for the treatment of select adult patients with intermediate- or high-risk myelofibrosis with thrombocytopenia based on findings from the phase 3 PERSIST-2 trial (NCT02055781), in which 29% patients who received the agent achieved a spleen volume reduction (SVR) of at least 35%. Among patients who received best available therapy, the SVR rate was 3%.1
He also explained the role of momelotinib (Ojjaara) for patients with anemia. Momelotinib was FDA-approved in 2023 for the treatment of adult patients with intermediate- or high-risk myelofibrosis and anemia based on data from the phase 3 MOMENTUM trial (NCT04173494).2 In MOMENTUM, 25% of patients who received momelotinib (n = 32/130) experienced a Myelofibrosis Symptom Assessment Form 4.0 total symptom score reduction of at least 50% vs 9% of those who received danazol (Danocrine; n = 6/65), translating to a treatment difference of 16% (95% CI, 6%-26%; P < .0095).3
Amanam is an assistant professor in the Division of Leukemia in the Department of Hematology & Hematopoietic Cell Transplantation at City of Hope in Duarte, California.