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Considering Fedratinib or Ruxolitinib in the Frontline Setting for Treatment of Myelofibrosis

Ruben Mesa, MD
Published Online:2:59 PM, Tue September 24, 2019

Ruben Mesa, MD, director of the Mays Cancer Center at UT Health San Antonio MD Anderson Cancer Center, discusses his experience with fedratinib (Inrebic) since its FDA approval for the treatment of patients with myelofibrosis (MF). The agent is compared across trials with ruxolitinib (Jakafi), which has been approved for several years in this space.

The most immediate impact for the approval of fedratinib is for the treatment of patients with MF who have not had an optimal response to ruxolitinib or who have lost their response and now may benefit from a new agent, says Mesa. However, there has not been a head-to-head comparison between these 2 agents. Both fedratinib and ruxolitinib have had very positive phase III studies, though their toxicity profiles are slightly different.

Mesa says there are additional subsets of patients who may also benefit from fedratinib because of significant splenomegaly, more advanced fibrosis, etc. Overtime, the agents will each find their niche in the frontline treatment landscape of MF, and it will become clearer after further investigation takes place, as well as with the prescribing of fedratinib to patients with MF. Its immediate utilization, however, is likely in the second-line setting, Mesa concludes.
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