Dr Klisovic on a Case Discussion of Momelotinib in Myelofibrosis With Anemia

Rebecca Klisovic, MD, chief medical information officer, University Hospitals Seidman Cancer Center, discusses 

3 case studies about patients with myelofibrosis

 State of the Science Summit™ on hematologic oncology, which she chaired.

The first case that was discussed was on a 71-year-old male patient with newly diagnosed myelofibrosis with splenomegaly, mild anemia, a high symptom burden, and intermediate-2–risk disease, Klisovic begins. The consensus among the panelists was that this patient required treatment due to his spleen size, symptoms, and anemia, she says. Although some oncologists who participated in the discussion considered using ruxolitinib (Jakafi) because of its early survival data, the panel predominantly favored momelotinib (Ojjaara), given this agent’s potential benefit in patients with anemia, she explains.

The second case was on a 62-year-old female patient with myelofibrosis who had already received ruxolitinib and had comorbidities including symptom scoring and a large spleen, according to Klisovic. This patient also had anemia, with a hemoglobin level of 7.2 g/dL, she reports. Therefore, the focus on improving anemia made momelotinib a clear treatment choice in this setting, she adds. Whereas other case presentations prompted treatment debates between the panelists, this case was more clear cut, especially since this patient was refractory to ruxolitinib, Klisovic emphasizes.

The third case was on a 54-year-old female patient with newly diagnosed myelofibrosis that was characterized by both anemia and thrombocytopenia, as well as a platelet count of 34/µL, Klisovic says. This discussion centered around the use of pacritinib vs momelotinib, informed by the patient’s low platelet count, she explains. Some discussants raised concerns about the patient’s eligibility for momelotinib clinical trials, which have enrollment criteria with varying platelet cutoffs, she notes. Despite these concerns, most participants favored the use of pacritinib (Vonjo) due to this agent’s efficacy in managing thrombocytopenia, she reports. However, some discussants noted that momelotinib could also be a viable treatment option for patients similar to the one in this case, depending on clinical trial criteria and individual patient factors, she concludes.

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Rebecca Klisovic, MD, discusses 3 case studies about patients with myelofibrosis.

Rebecca Klisovic, MD, discusses the early use of JAK inhibitors to treat younger patients with low-risk, newly diagnosed myelofibrosis. 

Dr Klisovic on the Early Use of JAK Inhibitors in Younger Patients With Low-Risk Myelofibrosis

Rebecca Klisovic, MD, chief medical information officer, University Hospitals Seidman Cancer Center, discusses a case study featuring a patient with newly diagnosed myelofibrosis and reviews the optimal JAK inhibitor–based treatment regimen for this patient, as determined by a panel of oncologists at an 

 State of the Science Summit™ on hematologic malignancies.

This case study featured a 40-year-old male patient with newly diagnosed myelofibrosis, Klisovic begins. She notes that the discussion about this patient was interesting discussion because the patient was young with low-risk disease. The panel’s conversation centered around the early use of the JAK inhibitor ruxolitinib (Jakafi) to potentially improve this patient’s overall survival outcome, Klisovic details.

Ruxolitinib has demonstrated superiority over placebo and best available therapy in the phase 3 COMFORT-I (NCT00952289) and COMFORT-II studies (NCT00934544). However, it was noted in the conversation that this patient would not have qualified for enrollment in the COMFORT studies due to his low-risk disease status, Klisovic explains. This led to a debate about the appropriateness of initiating treatment earlier rather than later, even in patients who may not otherwise require immediate therapy, according to Klisovic.

Another key question raised was whether ruxolitinib is truly disease-modifying, particularly in a younger patient, Klisovic says. This is a crucial consideration because the long-term benefits of a therapy and its potential for altering the disease course are significant factors in deciding early intervention, she expands.

Additionally, there was a strong recommendation to monitor this patient closely for transplant potential given his age, Klisovic continues. Although this patient’s molecular profile was not presented, discussants highlighted molecular stratification as an important factor for guiding treatment decision-making in similar cases, she states. Klisovic adds that the identification of higher-risk mutations could alter the treatment trajectory and influence whether early intervention or watchful waiting is more appropriate.

Overall, this case underscored the importance of individualized treatment planning in myelofibrosis, particularly for younger patients who may benefit from early intervention and close monitoring for potential curative options, such as transplantation.

Rebecca Klisovic, MD, discusses updates with JAK inhibitors, highlighting factors that inform JAK inhibitor selection in myelofibrosis.

Dr Klisovic on the Impact of Momelotinib on Myelofibrosis Management

Rebecca Klisovic, MD, chief medical information officer, University Hospitals Seidman Cancer Center consortium, discusses updates with JAK inhibitors in myelofibrosis, highlighting factors that inform JAK inhibitor selection in this space following an 

 State of the Science Summit™ (SOSS) on hematologic malignancies.

 for patients with intermediate or high-risk myelofibrosis, including primary myelofibrosis or secondary myelofibrosis, and anemia. The regulatory decision was supported by findings from the phase 3 MOMENTUM trial (NCT04173494) and data for a subpopulation of patients with anemia in the phase 3 SIMPLIFY-1 trial (NCT01969838). Momelotinib is currently the first and only therapy indicated for patients with anemia and myelofibrosis.

The approval of momelotinib adds to the growing array of treatment options for myelofibrosis, many of which have subtle differences in efficacy and safety profiles that may inform treatment selection, Klisovic states. This offers clinicians the ability to tailor therapy based on specific patient characteristics and needs, she adds. In a panel discussion at the SOSS event, Klisovic and colleagues expanded on the use of momelotinib and its role as a preferred choice for patients with myelofibrosis who experience challenges with anemia, among other topics. The positive data on anemia outcomes from clinical trials supported this decision, positioning momelotinib as an effective therapeutic option in this subgroup of patients, Klisovic summarizes.

In clinical practice, the selection of momelotinib upfront may be driven by the presence of anemia as a predominant toxicity, with the drug demonstrating efficacy in addressing this specific aspect of the disease, Klisovic continues. For patients with platelet counts lower than 25,000/µL, alternative JAK inhibitors such as pacritinib (Vonjo) may be favored due to safety profiles related to thrombocytopenia, she states.

Overall, momelotinib has expanded the treatment armamentarium for myelofibrosis and underscores the importance of personalized medicine in this setting, Klisovic concludes. With multiple treatment options available, clinicians can now optimize therapy based on individual patient characteristics and treatment goals, offering a more tailored approach to managing this complex disease.

Rebecca Klisovic, MD

Articles

Dr Klisovic on a Case Discussion of Momelotinib in Myelofibrosis With Anemia

Dr Klisovic on the Early Use of JAK Inhibitors in Younger Patients With Low-Risk Myelofibrosis

Dr Klisovic on the Impact of Momelotinib on Myelofibrosis Management