Dr. Bose on the Management of Patients With Myelofibrosis Who Progress on Ruxolitinib

Prithviraj Bose, MD, associate professor in the Department of Leukemia of the Division of Cancer Medicine at The University of Texas MD Anderson Cancer Center, discusses management strategies for patients with myelofibrosis who progress on ruxolitinib (Jakafi).

Finding appropriate approaches to manage patients who progress on ruxolitinib has proven to be very difficult, says Bose. Prior to the August 2019 FDA approval of the JAK inhibitor fedratinib (Inrebic), these patients had limited treatment options.

When ruxolitinib failed, hydroxyurea was used to control counts, and danazol was used to improve hemoglobin in these patients, says Bose. Thalidomide (Thalomid) or lenalidomide (Revlimid) were also appropriate to use. Immunomodulatory drugs that used to be very popular prior to ruxolitinib have also been utilized in this setting, adds Bose.

Another approach that is sometimes used consists of stopping ruxolitinib for some time and then re-starting patients on the agent. Re-challenging patients with the agent was another approach used prior to the approval of fedratinib, concludes Bose.