Frontline to Future: Considering the Role of Ruxolitinib Therapy in the Expanding cGvHD Landscape
A panelist discusses how chronic graft-versus-host disease affects 30-70% of allogeneic transplant patients across eight cardinal organs (most commonly skin), presents with varying symptoms from rashes and joint stiffness to dry eyes and lung complications, and requires graded treatment approaches ranging from topical therapies for mild cases to systemic corticosteroids for moderate-to-severe disease, though 50% of patients ultimately need alternative treatments due to steroid dependency or resistance.
A panelist discusses how four FDA-approved agents treat steroid-refractory cGVHD, including ibrutinib (65% response rate), belumosidil (74% response rate), ruxolitinib (50% vs 25% in phase 3 trial), and axatilimab (74% response rate with durable responses lasting 17.2 months median failure-free survival).
A panelist discusses how to sequence the four approved cGVHD agents based on patient-specific factors, recommending axatilimab or belumosidil for lung involvement, any of the three oral agents for skin/joint disease, and ibrutinib for lymphoma patients, while considering individual toxicity profiles and disease manifestations.
A panelist discusses how real-world experience with ruxolitinib and belumosidil shows similar response rates to clinical trials (45% and 65% respectively), emphasizes the importance of antimicrobial prophylaxis and supportive care, and describes gradual steroid tapering strategies once patients achieve responses.
A panelist discusses how patients with advanced cGVHD often cycle through multiple approved agents over time due to plateauing responses, and describes upcoming clinical trials testing upfront use of these novel agents with corticosteroids in newly diagnosed patients to potentially improve outcomes.
