Jax DiEugenio

Vonjo improves platelet counts and hemoglobin levels in patients with myelofibrosis.

Improvements in thrombocytopenia and anemia were observed in patients with myelofibrosis treated with Vonjo (pacritinib) in the real-world setting, as demonstrated in findings from a retrospective study presented at the 2024 SOHO Annual Meeting.

According to the National Cancer Institute, thrombocytopenia refers to a condition in which patients have a lower-than-normal number of platelets in the blood, and this can result in excessive bleeding from wounds and easy bruising. Anemia is a condition when patients have a low count of red blood cells.

Findings showed that patients with a platelet count below 100 x 10

/L (which is considered low) at baseline (74 patients) experienced an early increase in platelet count following treatment initiation that was maintained throughout the observation period. Additionally, an early increase in median hemoglobin (a protein inside red blood cells that carries oxygen from lungs to tissues and organs) was reported in all patients, and this increase was sustained throughout the observation period. Patients with hemoglobin level of less than 8 g/dL (a level that indicates anemia) at the start of treatment (35 patients) experienced a hemoglobin increase of nearly 1 g/dL by day 30.

Notably, patients who received prior treatment with Jakafi (ruxolitinib; 69 patients) experienced an increase in platelet counts and hemoglobin levels following initiation of Vonjo. At baseline, the median platelet count and median hemoglobin level in this population was 91 x 10

/L and 8.7 g/dL, respectively. At day 360, the median platelet count and median hemoglobin were 97 x 10

“In addition to spleen and symptom benefits observed in previous clinical trials, real-world outcomes demonstrate stability or improvement in thrombocytopenia and/or anemia in patients with myelofibrosis treated with [Vonjo],” lead study author Michael Marrone and colleagues, wrote in a poster presentation of the data. Marrone is an assistant professor in the College of Medicine, Department of Public Health Sciences, at the Medical University of South Carolina in Charleston.

This retrospective study evaluated the clinical and demographic characteristics, treatment patterns and outcomes of patients with myelofibrosis treated with Vonjo in the United States. In February 2022, 

the FDA granted accelerated approval to Vonjo

 for the treatment of adults with intermediate or high-risk primary or secondary (post-polycythemia vera or post-essential thrombocythemia) myelofibrosis with a platelet count below 50 x 10

Primary outcomes assessed were changes in platelet count and hemoglobin levels at the initiation of Vonjo — the index date — and in 30-day intervals post-index. Overall survival (the time when a patient with cancer is still alive; OS) was assessed from index date through the end of the observation period.

The study included 142 patients with myelofibrosis treated with Vonjo at a median follow-up of six months. In this population, 119 patients had complete laboratory values available at the index date and at least one once during follow-up.

Notably, at treatment initiation, 28.5% of patients had severe thrombocytopenia with a platelet count of less than 50 x 10

/L, and 29% had severe anemia with a hemoglobin level of less than 8 g/dL. The median age was 72 years, and the median time from diagnosis to Vonjo initiation was 13.4 months. The median time from index to the last dose of Vonjo or the end of the observation period was 5.3 months. In patients with a median follow-up of more than six months (78 patients), the median duration of Vonjo treatment was 8.5 months.

Additional data showed that the 12-month OS probability for patients with myelofibrosis treated with Vonjo was 69.4% in the overall cohort, which study authors noted was a favorable outcome compared with historical JAK inhibitor controls.

Patients who received Vonjo as a first-line therapy (52 patients) had a 12-month OS probability of 77.3%. Those with severe thrombocytopenia treated in the first-line setting (19 patients) had a 12-month OS probability of 75.2%.

Among patients treated with Vonjo in the second-line (59 patients), the 12-month OS probability was 72.1%. Patients previously treated with Jakafi prior to Vonjo had a 12-month OS probability of 65.3%.

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Articles

Vonjo was also shown to improve overall survival in patients with myelofibrosis treated with Vonjo in the real-world setting.

Vonjo Improves Thrombocytopenia, Anemia in Patients With Myelofibrosis

Patients with chronic lymphocytic leukemia (CLL) or small lymphocytic lymphoma (SLL) may be less likely to switch treatments and receive a subsequent therapy compared with those treated with Calquence (acalabrutinib) and Imbruvica (ibrutinib), according to findings from a real-world study.

Data presented at the 2024 Society of Hematologic Oncology (SOHO) Annual Meeting showed that irrespective of whether patients were treated with a BTK inhibitor in the first or second line, the switching rate at 60 days or less and 61 to 89 days was lower for patients receiving Brukinsa (zanubrutinib) compared with those receiving Calquence and Imbruvica.

Patients with CLL or SLL treated with Brukinsa may be less likely to switch treatments compared to those on Calquence or Imbruvica.

Brukinsa is a BTK inhibitor, a type of drug that targets cancer cells.

The study suggests that Brukinsa might be a more effective and durable treatment option for patients with CLL or SLL.

Of note, BTK inhibitors are a class of drugs that targets an enzyme that is important in the development and function of B cells, which helps the body defend itself against infections. Blocking this enzyme can disrupt signals that help cancer cells grow and survive.

In the first-line setting, the rate of patients switching therapies before 90 days was 10.2% for Brukinsa (157 patients) compared with 20.5% for Calquence (1,238 patients) and 15.9% for Imbruvica (1,421 patients). In the second-line setting, the switch rate before 90 days was 7.5% for Brukinsa (107 patients), 13.2% for Calquence (672 patients), and 21.1% for Imbruvica (474 patients).

“This study highlighted the real-world advantages of [Brukinsa] compared [with] other BTK inhibitors in patients with CLL/SLL,” lead study author Dr. Javier Pinilla-Ibarz and colleagues, wrote in a poster presentation of the data. “Future studies with extended follow-up are necessary to facilitate evaluation of emerging therapies and to assess long-term real-world outcomes.”

Pinilla-Ibarz is a senior member and head of the Lymphoma Section in the Department of Malignant Hematology at Moffitt Cancer Center in Tampa, Florida.

The retrospective study evaluated real-world switching and sequencing to next-line therapies among patients with CLL or SLL initiating BTK inhibitors in the first-line or second-line setting.

Investigators gathered data for patients at least 18 years of age with CLL or SLL who initiated treatment with Calquence, Imbruvica or Brukinsa.

In the study, a total of 2,816 patients initiated first-line BTK inhibitor therapy; 1,253 patients began second-line treatment. In the first-line setting, Imbruvica was the most frequently used BTK inhibitor (50.5%), followed by Calquence (44%) and Brukinsa (5.6%). In the second-line setting, Calquence was most commonly used (53.6%), followed by Imbruvica (37.8%) and Brukinsa (8.54%).

Demographic and clinical characteristics were assessed at the start of the study, and study authors noted that there were no significant differences in age, sex, payer type or Rai stage (a system to classify the severity of CLL) among the three cohorts. The median follow-up duration in the first-line setting was 123 days for Brukinsa, 406 days for Calquence and 637 days for Imbruvica. In the second-line setting, median follow-up durations were 133 days for Brukinsa, 503 days for Calquence and 524 days for Imbruvica.

Treatment switching was measured by identifying patients who initiated another treatment within the same line or advanced to the next line of therapy within 90 days.

Additional data showed the switching rates before 60 days in the first-line setting were 10.2% for Brukinsa, 17.1% for Calquence and 13.1% for Imbruvica. The respective switching rates from 61 to 89 days were 0%, 3.4% and 2.5%. In the second-line setting, the switching rates before 60 days were 7.5% for Brukinsa, 10.7% for Calquence and 17.1% for Imbruvica. The switching rates from days 61 to 89 were 0%, 2.5% and 4%, respectively.

The proportion of patients who received their next line of therapy at 180 days was lowest for those treated with Brukinsa. In the first-line setting, 13.9% of patients treated with Brukinsa received next-line therapy by day 180 compared with 24.5% of patients treated with Calquence and 21.1% of patients treated with Imbruvica. In the second-line setting, these rates were 9.1% for Brukinsa, 18.6% for Calquence and 29.2% for Imbruvica.

The authors noted that the study was limited to a United States–based population, which may not be applicable to all patient populations. They also explained data may be limited by the real-world nature of the study.

Treatment with Brukinsa may lower the rates of switching therapies compared with Calquence and Imbruvica in chronic lymphocytic leukemia.

Jax DiEugenio

Vonjo Improves Thrombocytopenia, Anemia in Patients With Myelofibrosis

Treatment Switching May Be Less Likely With Brukinsa vs Other BTK Inhibitors in CLL/SLL

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