Choosing Interferon Treatment for Patients With Myeloproliferative Neoplasms

Anthony Hunter, MD, Emory University, Atlanta, Georgia, explores the use of interferon regimens in the current treatment landscape for patients with myeloproliferative neoplasms, including polycythemia vera (PV) and essential thrombocythemia (ET).

Transcript:

My name's Anthony Hunter, I'm an assistant professor in the Leukemia Group here at Winship Cancer Institute of Emory University and particularly focused on myeloproliferative neoplasms. 

Interferons are something we've been studying and using for quite a bit of time now in myeloproliferative neoplasms, including polycythemia vera and essential thrombocythemia.

I think it's something that in clinical practice, a lot of people maybe don't have a ton of familiarity with. We do use this more at larger academic centers and [they] have been used historically in the community. But, I think, certainly an important option in our PV and ET patients as well. We've seen ropeginterferon approved a little over a year ago now for PV patients, sort of the first approval for an interferon product in myeloproliferative neoplasms. 

As I talk about with my patients, interferon is maybe a little bit higher risk, and that we can sometimes see a little bit more side effects sometimes [than] with what we maybe see with [hydroxyurea] (hydrea), although that may be improving with some of our newer options, but also a little bit more potential for higher reward.

We do see good count control with agents like this, potentially more sustained than what we see with hydrea. If you look at some of the longer-term follow-up of, for example, the CONTINUATION-PV study with ropeginterferon. As well we see a little bit more potential to improve allele reduction, so in longer-term follow-up with multiple studies of interferon, we see patients maybe in the 15% to 20% range of really significant reductions in the JAK-2 allele frequencies, sometimes getting down to undetectable or less than 1% level. So, really signifying a little bit more potential for disease modification with these agents than what we see with hydrea, certainly there's been some retrospective data that suggested this as well.

I think interferon certainly is an important option for these patients, in particular in younger patients and patients that are more enthusiastic about doing something that may affect the disease and potential for more disease-modifying capacity long-term. I think interferon agents are very important and we are seeing more usage now with agents like ropeginterferon having been improved specifically for PV patients now, with more convenient dosing with just every 2 weeks, which can be expanded to every 4 weeks after a year on therapy for those patients who are well-controlled.

Certainly beyond interferon, we see ruxolitinib. It has been approved for a little while now, in the second-line setting in polycythemia vera, based on the RESPONSE studies, but we did also recently see data from the MAJIC-PV study come out, with some longer-term follow-up from ruxolitinib use in PV in that study as well. 

And certainly in patients, especially with a couple of years of use of ruxolitinib also seeing substantial variant allele frequency reductions with ruxolitinib use as well, which is some of the best data we've seen with this particular agent looking at that. Not only that, we're just seeing that, but in one of the first prospective studies anyway, really showing that this actually did correlate with improvements in progression-free survival (PFS) in these patients as well. 

So, for years our management of ET and polycythemia vera has really been to try to control the counts and improve that thrombotic risk rate, but we’re really starting to move beyond that a little bit, with some options that have more capacity to really target the disease, and have more potential long-term effects, improving the potential for disease modification and decreasing the rates of progression as well.