A thought leader in hematologic malignancies provides key insights into the future of treatment for polycythemia vera by considering the potential role of treatment sequencing or combination therapy.

EP. 1 : Myeloproliferative Neoplasms: Diagnosing Polycythemia Vera

EP. 2 : Risk Stratification and Treatment Considerations in PV

EP. 3 : PV Treatment Options and Dosing

EP. 4 : The JAK2 Pathway in Polycythemia Vera

EP. 5 : Ruxolitinib in PV: The RESPONSE Trial

EP. 6 : Ruxolitinib in PV: The RESPONSE-2 Trial

EP. 7 : Future Directions in the Treatment of Polycythemia Vera

Jamile Shammo, MD, FASCP, FACP: We now have optionsfor patients who have polycythemiavera [PV]. I know that other options may be available in the future for patients who have this entity. I think that its a good thing that we should be able to offer our patients multiple options.Clearly, patients whohavehad issues with enlarged spleen arent able to tolerate hydroxyurea, and people who had heavy burden with phlebotomy may not be able to tolerate phlebotomy,soruxolitinib presents a very good option for the treatment of their disease.For patients who are interested in having children in a few months, thismay represent a good option for them to achieve that goal.For patients who dont have that possibility or who had failedall ofthe abovetreatments, we will have clinical trials so that we can offer them novel agents that would have the potential for controlling their disease moving forward.

It would be important to see what the clinical trials would bring. I would think that combination therapies may be most helpful in more advanced disease entities like myelofibrosis where you can justify the risk of combination therapy because its a much more aggressive disease than it would be the case with PV.Perhaps you could consider that in advanced PV, or maybe you could consider this in patients with PV and multiple mutations.Ithas tobe considered in a certain group of patients. I dont know that I would necessarily consider combination therapy in all-comers with PV. Ithas tobe thought of in a rational fashion.

We need to understand this group of patients better on a molecular level.We know a lot about the landscape of their molecular profiles, but we know less about how to treat that. We know less about the landscape of people who relapseafter a particular treatmentand how to address thatparticular treatment, for example. We probably need to know more about how to utilize transplant in that setting.Theres a lot to be learned about how to use this.

Of course, there is also awhole slew of JAK[Janus kinase]inhibitors that may have various properties as well. It isinteresting to think about utilizing them pre-and post-transplant. Thereare a whole slew of biological agents that could be combined with JAK inhibitors to see how we can make the most out of that combination. We can learnhowthey canbe explored either alone or in combination with stem cell transplantation.Theres a lot that needs to be done, but all thathas tobe done in the context of a clinical trial.It probably starts with understanding more about the disease biology,taking it to some type of a clinical trial, andkeeping our eyes opentoget an observation to translate that into some type of conclusion that may be beneficial to patients.

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Future Directions in the Treatment of Polycythemia Vera - OncLive