Dr Kuykendall on Sequencing Rusfertide in Polycythemia Vera

Andrew Kuykendall, MD, discusses where rusfertide (Mimrylo) may fit within the treatment paradigm for polycythemia vera and how the agent could be used at different points in the disease course. Kuykendall, of Moffitt Cancer Center, explains that rusfertide is unique because it does not necessarily slot into one specific place in the treatment paradigm, and he notes that it is causing clinicians to rethink that paradigm. In his view, rusfertide allows for a more individualized approach to creating treatment plans for patients. Rather than occupying a single line of therapy, rusfertide is described as an option that can be considered across a range of clinical situations.

According to Kuykendall, the most straightforward way to position rusfertide is as a potential replacement for phlebotomy altogether in patients who are struggling with it or who have challenges with phlebotomy. He describes the agent as particularly useful for patients looking to move beyond this somewhat “archaic” approach to controlling their disease. Some patients have difficulty coming in for phlebotomies, keeping up with them, and receiving them appropriately. For these patients, Kuykendall explains, rusfertide shows the ability to independently self-administer medication to achieve consistent control of hematocrit.

Kuykendall also outlines several patient scenarios beyond replacing phlebotomy where rusfertide could be considered. It could be looked at early in the disease, when patients are receiving a lot more phlebotomies. It could also be considered in patients who are on cytoreductive therapy but still need phlebotomies. These patients may otherwise have to be on higher doses of their cytoreductive therapy to control their phlebotomy requirements, and they may not tolerate those higher doses well.

Kuykendall is particularly intrigued by the potential role of rusfertide in patients who experience profound fatigue. He describes a group of patients who feel terrible and feel they cannot live the life they used to live or want to live. This happens regardless of what they are treated with, and even when they are considered at goal and clinicians are hitting their marks. He is especially interested in how rusfertide might move the needle for these patients, who struggle on a day-to-day basis.

Overall, Kuykendall sees rusfertide as an agent that can be thought about in many different patients at different points during their disease course. He frames the central question as whether rusfertide can be added to a patient's current standard of care to accomplish something that has not been possible with the other therapies currently available.