Ruben A. Mesa, MD

Ruben A. Mesa, MD, director of the Mays Cancer Center at UT Health San Antonio MD Anderson Cancer Center, discusses the potential utility of CAR T-​cell ​therapy in myeloproliferative neoplasms (MPNs).

In recent years, cellular therapy has evolved rapidly in lymphoid malignancies, especially in lymphoma and ​multiple myeloma, says Mesa.

Notably, at the Institutional Perspectives in Cancer webinar on Leukemia and Lymphoma, Paul ​J. Shaughnessy, MD, of Methodist Hospital, expanded on these data and provided insight on future directions of CAR T-cell therapy ​in hematologic malignancies.

The utility of cellular-based therapy, in both hematologic and non-hematologic malignancies, has sparked great interest ​across oncology. Encouraging data suggest CAR T-cell therapy may soon find a place in the MPNs space, ​concludes Mesa.

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Ruben A. Mesa, MD, discusses the potential utility of CAR T-​cell ​therapy in myeloproliferative neoplasms.

Dr. Mesa on the Potential Utility of CAR T-Cell Therapy in MPNs 

Ruben A. Mesa, MD, director of the Mays Cancer Center at UT Health San Antonio MD Anderson Cancer Center, discusses the potential clinical benefit of rechallenging with JAK inhibitor therapy in patients with myeloproliferative neoplasms (MPNs).

Preclinical and anecdotal data ​suggest that holding ruxolitinib (Jakafi) may yield some clinical benefit for patients, says Mesa.

Particularly, this method may have utility for patients who are ineligible for clinical trials or do not have access to fedratinib (Inrebic)​, Mesa explains.

​Determining whether a patient has disease progression is critical when considering this strategy as rechallenging with ruxolitinib may not be beneficial in patients who have not progressed, concludes Mesa.

Ruben A. Mesa, MD, discusses the potential clinical benefit of rechallenging with JAK inhibitor therapy in patients with myeloproliferative neoplasms.

Dr. Mesa on Rechallenging With JAK Inhibitor Therapy in MPNs

Ruben A. Mesa, MD, director of the Mays Cancer Center at UT Health San Antonio MD Anderson Cancer Center, discusses recent data with momelotinib in myelofibrosis.

In myelofibrosis, there are currently agents such as ruxolitinib (Jakafi) and fedratinib (Inrebic), both of which have been approved in the frontline setting; fedratinib also has good data in the second-line setting, says Mesa. These agents can improve splenomegaly symptoms and are likely have an impact on survival, yet there are still unmet gaps with these agents in the field. There are some important potential differentiators with the JAK inhibitors that are still in development, adds Mesa.

Momelotinib, for example, has been shown to potentially improve anemia and splenomegaly symptoms. Data suggest that activity with momelotinib inhibits hepcidin, which may create a state of anemia, chronic disease, and inflammation. Hepcidin inhibition might be a reason why patients on momelotinib are seeing improvements in anemia. There are further studies ongoing looking at momelotinib as a second-line therapy versus danazol (Danocrine) as a control in terms of improving anemia and splenomegaly symptoms in patients with myelofibrosis, concludes Mesa.

Dr. Mesa on Recent Data With Momelotinib in MPNs and Myelofibrosis

Ruben A. Mesa, MD, director, UT Health San Antonio MD Anderson Cancer Center, discusses advancements made in the treatment of patients with myeloproliferative neoplasms (MPNs).

It is an exciting time in terms of therapeutic progress made in MPNs, says Mesa. First, there have been further updates on the important role of long-acting interferons in the treatment of patients with essential thrombocythemia or polycythemia vera. Long-acting interferons are having an impact on outcomes and are possibly superior to the use of hydroxyurea, in both the first- and second-line settings. Data presented at the 2019 ASH Annual Meeting with long-acting interferons showed both thrombosis-free survival as well as a potential molecular impact in this space, says Mesa.

In myelofibrosis, a very robust set of therapies are being developed, adds Mesa. For example, investigators are examining a group of JAK inhibitors that are expected to complement each other in terms of their activity. Additionally, novel combinations comprised of drugs with different mechanisms of action, such as BET, TGF-β, and LSD1 inhibition, are also under exploration. New drugs are also in development for use as single agents, says Mesa.

We’re seeing parallel advances in the treatment of patients with myelodysplastic syndromes with oral hypomethylating agents; these agents will certainly have a benefit for patients with advanced MPNs, as well, concludes Mesa.

Ruben A. Mesa, MD, discusses advancements made in the treatment of patients with myeloproliferative neoplasms.

Author | Ruben A. Mesa, MD

Articles

Dr. Mesa on the Potential Utility of CAR T-Cell Therapy in MPNs

Dr. Mesa on Rechallenging With JAK Inhibitor Therapy in MPNs

Dr. Mesa on Recent Data With Momelotinib in MPNs and Myelofibrosis

Dr. Mesa on Treatment Advancements Made in MPNs