Adding hydroxyurea in combination with ruxolitinib improves clinical responses in hyperproliferative forms of myelofibrosis.

Abstract

Ruxolitinib, an orally bioavailable and selective inhibitor of Janus kinase 1 (JAK1) and JAK2, significantly reduces splenomegaly and disease-related symptoms in patients with myelofibrosis (MF). However, no clear survival benefit has been demonstrated, which may in part reflect suboptimal drug exposure related to lower dosages needed to minimize hematological toxicity, specifically cytopenias. Furthermore, the optimal management of specific conditions such as leukocytosis or thrombocytosis in patients under ruxolitinib therapy is still undefined. In these cases, combining ruxolitinib with a cytoreductive agent like hydroxyurea might improve hematological response. This observational multi-center study enrolled 20 adult patients with intermediate- or high-risk primary MF, post- polycythemia vera MF, or postessential thrombocythemia MF with hyperproliferative manifestations of the disease and WBC and/or platelet counts not controlled by ruxolitinib therapy. The patients received treatment with a combination of ruxolitinib and hydroxyurea. A clinical response of any type was obtained in 8 patients (40%) during ruxolitinib monotherapy and in 17 patients (85%) during ruxolitinib-hydroxyurea combination (P = 0.003). After a median duration of 12.4 months of combination therapy, 16/20 patients had a hematological response; 14/17 patients who had started combination therapy to control WBC count and 2/3 who started in order to reduce platelets count. The number of patients requiring ruxolitinib dosage reduction or discontinuations was lower during combination therapy and, at the end of follow-up the median ruxolitinib dose was increased in 50% of patients. In conclusion, the combination of hydroxyurea with ruxolitinib yielded a high clinical response rate and increased ruxolitinib exposure in patients with hyperproliferative forms of MF.

• Authors: Novella Pugliese, Claudia Giordano, Davide Nappi, Luigiana Luciano, Claudio Cerchione, Mario Annunziata, Beniamino Casale, Elena Crisà, Maria Rosaria Villa, Luca Pezzullo, Maria Iovine, Marco Picardi, Francesco Grimaldi, Fabrizio Pane, Vincenzo Martinelli
• Journal: Cancer medicine (Cancer Med) Vol. 8 Issue 6 Pg. 2802-2809 (06 2019) ISSN: 2045-7634 [Electronic] United States
• PMID: 30997748 (Publication Type: Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)
• Copyright: © 2019 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.

Chemical References

• Antineoplastic Agents
• Biomarkers
• Janus Kinase Inhibitors
• Nitriles
• Pyrazoles
• Pyrimidines
• ruxolitinib
• Hydroxyurea

Topics

• Adult
• Aged
• Aged, 80 and over
• Antineoplastic Agents (administration & dosage, adverse effects, therapeutic use)
• Biomarkers
• Drug Therapy, Combination
• Female
• Humans
• Hydroxyurea (administration & dosage, adverse effects, therapeutic use)
• Janus Kinase Inhibitors (administration & dosage, adverse effects, therapeutic use)
• Male
• Middle Aged
• Nitriles
• Primary Myelofibrosis (diagnosis, drug therapy, metabolism)
• Pyrazoles (administration & dosage, adverse effects, therapeutic use)
• Pyrimidines
• Retrospective Studies