Published on October 22, 2015
As part of our Ask the Expert series, Dr. Jason Gotlib from Stanford Cancer Institute answers a community member’s question pertaining to alternative JAK inhibitors and the possibility of achieving remission. Dr. Gotlib discusses this class of medications and what role they play in the treatment of MPNs. He goes on to explain “cure” and how stage of disease relates the possibility of remission.
Transcript | Is It Possible to Achieve Remissions With MPNs?
Okay. All right. Here's a question, Dr. Gotlib, we got in from Robert, who says, What's the alternative to Jakafi, or ruxolitinib, in order to achieve remission? Is it possible to achieve remissions with MPNs? So sort of two-part—alternative, and can you get into remission.
So the term "remission," I think the devil's in the details, so one needs to be very careful about the terms that one uses. So when I think of a drug like ruxolitinib or another JAK inhibitor what we achieve with drugs of that class are improvement of spleen size and associated disease-related symptoms. Generally, for most patients, don't see significant reversion of bone marrow fibrosis, nor do I use the word "cure" in those patients. But if one is talking about symptom remission, I think those drugs, the JAK inhibitors, are incredibly useful.
Now, if one goes to the other spectrum in terms of disease-modifying treatments or high-intensity treatments, for example, stem cell transplantation, that's a higher intensity modality that actually can cure patients, that is, put them into a long?term disease-free survival or remission in about, if you take all patients, for example, with myelofibrosis, perhaps 40 percent, but really there are many patients and disease factors that play into that remission rate.
So it really depends what the stage of disease is, what the patient's performance status or activity level is, what their other co-morbid conditions are, what the class of drug we're talking about, and those are the factors that really decide whether we can achieve remission or whether we can achieve a cure and what we talk about when we talk about remission and the term "cure."