Dr. Gabriela Hobbs provides insight into the future of myelofibrosis care, explaining how research is moving beyond symptom relief toward therapies that target the underlying biology of the condition. Dr. Hobbs shares optimism that the next generation of therapy may help people with myelofibrosis live longer and better.
Dr. Gabriela Hobbs is a hematology-oncology physician specializing in the care of patients with myeloproliferative neoplasms (MPN), chronic myeloid leukemia, and leukemia. Dr. Hobbs serves as clinical director of the adult leukemia service at Massachusetts General Hospital. Learn more about Dr. Hobbs.
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Transcript
Jamie Forward:
So, how might these new developments, as we look towards the future, be changing the overall treatment landscape for people with myelofibrosis?
Dr. Gabriela Hobbs:
I am sure that the treatment landscape for MF in 5 to 10 years is going to look really different. So, right now the focus of our treatment is to give a JAK inhibitor that, although has been transformative for the management of myelofibrosis, they’re really primarily palliative therapies. It’s true that for some patients and certain subgroups they may live longer with these therapies than without them and that should not be underestimated. That’s super important. The newer generations of therapies, I think, are actually going to target the underlying disease biology, and so that’s really going to change the face of MF.
So, on the one hand, I really feel very optimistic about the CALR mutant-targeted therapies. We just saw an antibody. And maybe by itself it’s not going to be enough, but there’s a variety of other CALR mutant therapies that are being developed, like T-cell engagers and antibody drug conjugates and things like that where we’ve seen in other hematologic malignancies that they can really be transformative for the outcomes of patients with those mutations.
And for our non-CALR mutated patients, there are several drugs in development that are aiming to better target the JAK2 mutation.
So, whereas the previous JAK inhibitors that we have just kind of non-selectively block the JAK-STAT signaling pathway, the new agents that are being developed really are aiming to actually block the pathway selectively and preferentially for the JAK2 mutation. And again, I think that those will also have a lot of promise. And so, being the mutation-specific therapies, I think it’s to be determined.
But there’s still lots of different combination strategies that are being utilized, and I imagine that although not all of them will get approved, some of them probably will. And so, I mentioned nuvisertib. I mentioned pelabresib. But there’s also selinexor (Xpovio), imetelstat (Rytelo), navtemadlin, amsulostat. There are so many different agents that are being studied in combination. And beyond these kinda novel inhibitors, to treat the underlying disease, there’s also supportive care medications that I think we’re going to be utilizing. So, I think, for now, we’re using luspatercept (Reblozyl), for example, for our anemic patients, although the most recent study was kind of disappointing in terms of its outcomes.
But clinically we all utilize it and it seems to be very efficacious, especially in combination with ruxolitinib. There are other agents, like I was mentioning before, elritercept or the DISC compound that can also help with anemia because anemia really does remain a significant problem for the management of MF patients.
Jamie Forward:
So, Dr. Hobbs, is there anything you’d like to add about the evolution of myelofibrosis care? What are you excited about?
Dr. Gabriela Hobbs:
Well, I think, as you heard from my answers, I’m excited about a lot of things. It’s really fascinating to see how before 2011 we didn’t have any medications for this disease. We didn’t even know about many of the mutations that caused this disease. And now, we have four approved JAK inhibitors, some supportive care medications available, and there’s so many medications that are being studied. So, I feel truly optimistic for the future of care of myelofibrosis patients over the next 5 to 10 years. I really think that we’re going to have kind of the next generation of therapies that are really going to offer patients truly targeted therapy that will help them live longer and live better with their disease.