New data challenges conventional thinking that low-risk patients with myeloproliferative neoplasms are treated primarily with phlebotomy and aspirin alone, showing benefit from drugs such as ropygin interferon, Memorial Hospital says. said Rajit Rampal, MD, associate attending physician and hematology-oncologist. Sloan Kettering Cancer Center.
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Interferons have been around for decades, but are there any unanswered questions about their use?
I think the important thing is when, who starts treatment, and for how long. For me, these are kind of important questions. Relatively recent data have looked at treating low-risk polycythemia vera patients with ropegin interferon compared to our traditional treatments such as phlebotomy and aspirin. At least there appears to be some indication that these patients may benefit. Our traditional thinking is to leave the patient alone, except for bloodletting and aspirin, and then give medication if there are blood clots, symptoms, etc. Otherwise, treat only if the risk is high. But this data was actually provocative in the sense that “when treating these low-risk patients, there may be a clinical benefit to starting treatment earlier.”
That begs the question, but I don't think it's a matter of results. This means that patients should be treated early in the course of the disease with drugs like interferon, which not only deplete some of the stem cells that cause the disease, but can also precipitate the patient into a diseased state. I mean, is it? Is their disease well-controlled clinically? I think that has to be resolved.
There is data in France where interferon was discontinued after several years of treatment. So is it something that should be explored as part of a paradigm shift? Or you could say: “Listen, we have a limited amount of time to treat patients. If the disease is under control, we may be able to stop it, monitor it, and withdraw if necessary.”
So it would be a complete change from the current treatment paradigm. These are questions that are not widely answered, and I think they should be considered.
How do you determine disease control is strong enough to warrant discontinuation of treatment?
We're not there yet. The published studies were retrospective in nature, essentially examining how long a patient's response lasted if treatment was discontinued based on various clinical factors. But is there currently any guidance on who should be considered for this? No, I think we need future data to know the answer.