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ASH 2025 | Guidance for selecting between JAK inhibitors in the frontline and second-line setting for MF
Ruben Mesa, MD, Levine Cancer Institute, Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston Salem, NC, gives guidance on selecting between JAK inhibitors for the treatment of myelofibrosis (MF). He discusses patient characteristics in both the frontline and second-line settings that may favor one of the available agents. This interview took place at the 67th ASH Annual Meeting and Exposition, held in Orlando, FL.
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Transcript
I think starting with the best drug for this situation on the front end is key. There’s a case for the front line in each of them. Ruxolitinib is the standard of care if everything is good. They don’t have cytopenias, there’s no contraindications. They don’t have a big burden of prior skin cancers. For fedratinib, I particularly think of in the frontline setting, if they have a lot of prior skin cancers, their blood counts are good...
I think starting with the best drug for this situation on the front end is key. There’s a case for the front line in each of them. Ruxolitinib is the standard of care if everything is good. They don’t have cytopenias, there’s no contraindications. They don’t have a big burden of prior skin cancers. For fedratinib, I particularly think of in the frontline setting, if they have a lot of prior skin cancers, their blood counts are good. Pacritinib for patients with really severe thrombocytopenia. And momelotinib for that baseline anemia and or thrombocytopenia. So one, there’s a frontline case. Two, second line, where again, I think a key with ruxolitinib is that’s your starting agent. If there really is not a key response by three and six months, looking at different prognostic scores that share with us, predictors of those that don’t do as well for the long term, using the RR6, the key unmet need is keeping people on ruxolitinib past the time where it’s clear that they’re not going to have a great response and then move on to one of the other agents based on the presence of cytopenias or momelotinib or pacritinib or if no cytopenias, thinking of fedratinib in that second line setting.
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