Myeloproliferative neoplasms (MPNs) are complex diseases, with current therapies primarily designed to prevent complications and reduce symptoms. In this insightful interview, Ruben Mesa, MD, from UT Health San Antonio Cancer Center, San Antonio, TX, USA, gives his opinion on the most important areas to the advancement of MPN treatment, including whether the treatment of patients needs to occur earlier. Dr Mesa emphasizes the need for the approval of further JAK inhibitors alongside ruxolitinib, and touches upon a few of the drugs that are currently in development, such as the phase III JAKARTA trial of fedratinib (NCT01437787). He also mentions brand new therapies that are showing potential, such as Nutlins that act upon the p53 pathway, and a combination therapy of navitoclax with ruxolitinib (NCT03222609). This video was recorded at the Myeloproliferative Neoplasms Advances Day 2017, London, UK.