Aaron Gerds on JAK Inhibitor Therapy for Anemic Patients With Myelofibrosis

Aaron T. Gerds, MD, MS, unpacks data seen with momelotinib for patients with anemic myelofibrosis.

Anemia is a common problem with myelofibrosis and can lead to a significant patient burden, according to Aaron T. Gerds, MD, MS. However, JAK inhibitors have demonstrated encouraging efficacy in this arena.

Gerds, who isan assistant professor in medicine (hematology and medical oncology) at the Cleveland Clinic Taussig Cancer Institute, recently presented findings from the phase 3 MOMENTUM trial (NCT04173494), which showed that in the open-label continuation phase, patients with myelofibrosis who have anemia and previously received a JAK inhibitor who stayed on momelotinib experienced durable transfusion independent, splenic response, and symptoms improvement. This was also observed in patients who or crossed over from danazol (Danocrine) to receive momelotinib.

In an interview with Oncology Nursing News®, Gerds discussed the findings from MOMENTUM, the trajectory of JAK inhibitors for the treatment of myelofibrosis, and whether momelotinib can contribute to the JAK inhibitor momentum; as well as the potential benefit these drugs can offer for patients with myelofibrosis who have anemia.

For patients on the momelotinib-to-momelotinib arm (n = 130), the week 24 symptom responses were sustained through week 48 of treatment in 97% of patients. This occurred in 100% of patients in the danazol-to-momelotinib arm (n = 40).1

Additionally, for the patients who did not have a Total Symptom Score (TSS) response to danazol and therefore crossed over to momelotinib at week 24, 29% experienced a TSS at 48 weeks. Also at week 48, 20% of patients who continued momelotinib in the open-label phase from momelotinib in the double-blind phase experienced a TSS.1

Early crossover to momelotinib was permitted if disease progression was confirmed. In the open-label crossover phase after 24 weeks of treatment, momelotinib was given at 200 mg daily.


“This study selected patients who had previous JAK inhibitor exposure, were anemic and also significantly symptomatic and had large spleens. It was looking to see if momelotinib was a better option for these patients,” Gerds explained. “Danazol was chosen as a comparator because it is an active agent in remedying anemia in these folks, and momelotinib is a special JAK inhibitor that not only can shrink spleens and improve symptom burden, but it can also have a potential effect on anemia through inhibition of ACVR1.”


“The first key take-home point from the data we presented was that there were no new toxicity or safety signal seen. The data was very consistent [with] what we saw in the original 24-week analysis. This is, of course, incredibly important when you think about the fact that these [patients] might be on this medication for a long time,” he added. “Moreover, the responses were quite durable. Patients who responded at week 24 continue to respond through week 48, whether we’re talking about transfusion independence, spleen volume response or symptom burden improvement.”

An interesting point from the data, according to Gerds, is that patients who did not show an original symptom response during their first 24 weeks of treatment did so during the next 24 weeks, indicating that additional therapy may be beneficial. Moreover, investigators looked at different platelet count cutoffs, and the response rates were similar no matter what the platelet count threshold was for that ad hoc analysis.

“That’s important because thrombocytopenia [can] often co-occur with anemia,” he noted. “So, if you have a drug that treats anemia, you also want [it to] have efficacy in patients who are thrombocytopenic.”

Reference

  1. Gerds AT, Mesa RA, Vannucchi AM, et al. Updated results from the Momentum phase 3 study of momelotinib (MMB) versus danazol (DAN) in symptomatic and anemic myelofibrosis (MF) patients previously treated with a JAK inhibitor. Blood. 2022;140(suppl 1):1514-1515. doi:10.1182/blood-2022-162783

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