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JAK inhibitors for the treatment of MF: Latest updates from IACH
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MF is a MPN that is characterized by fibrosis in the bone marrow, often resulting in anemia, splenomegaly, and other symptoms including fatigue and weakness.1 MF is often driven by mutations in the JAK-STAT signaling pathway, in particular in the JAK2V617F gene. JAKis are a mainstay for the treatment of MF due to their action of blocking overactivity in this pathway.1 During the 7th Annual Meeting of the IACH, Pemmaraju delivered a presentation on JAKi combinations for the treatment of MF, touching upon the history of development, as well as the current paradigm and future directions. |
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Currently, there are four approved JAKis for the treatment of MF, including ruxolitinib, fedratinib, pacritinib, and momelotinib. |
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Transplant remains the only curative option for MF. However, further investigation may reveal the impact of sequencing JAKis (pre- or post-transplant or splenectomy) on outcomes associated with transplant. |
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Pacritinib exhibits 4-fold higher potency for ACVR1 inhibition compared with momelotinib. Therefore, pacritinib may be of benefit in patients with greater disease-related symptoms associated with the ACVR1 pathway, such as anemia. |
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As treatment advances, future goals for treatment may include disease modification and OS benefit, beyond the typical goals of spleen and symptom reduction. |
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There are multiple ongoing clinical trials combining JAKis with other agents, including novel therapies such as luspatercept, selinexor, and pelabresib. |
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Future developments include investigating novel targets for advanced MPN, as well as developing mutant-specific therapies to target individual mutations such as JAK2 and CALR. |
Abbreviations: ACVR1, activin A receptor type 1; IACH, International Academy for Clinical Hematology; JAKi, Janus kinase inhibitor; MF, myelofibrosis; MPN, myeloproliferative neoplasms; OS, overall survival; STAT, signal transducer and activator of transcription.
- Pemmaraju N. 7th Annual Meeting of the International Academy for Clinical Hematology; Sep 19–21, 2024; Paris, FR.
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