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Interview with Dr. Srdan Verstovsek - ASCO 2014 | Part II
Medical oncologist and Professor in the Department of Leukemia, MD Anderson Cancer Center, Houston, Texas, USA
Interview by Dr. Guido Marcucci, Division of Hematology, Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio, USA with Dr. Srdan Verstovsek, medical oncologist and Professor in the Department of Leukemia, MD Anderson Cancer Center, Houston, Texas, USA.
Dr. Marcucci refers to the RESPONSE trial of which Dr. Verstovsek spoke before (in PART I). This was a large, multinational study. Such an approach is needed if you want to study complex issues in such relatively rare disorders. From a collaboration perspective, where does the oncology field stand in the use of molecular markers as surrogate markers for a better disease response and to assess if the treatment is modifying disease history?
Dr. Verstovsek agrees that with such rare diseases, you need collaborations. Myeloproliferative neoplasms and polycythemia vera (PV) in particular are rare diseases, and until the discovery of the influence of JAK2, these were basically neglected, as the field was generally satisfied with what could be done. Before that time there were hardly any activities, no collaborative studies. With JAK2 inhibitors arrival, and the approval of the first drug for myelofibrosis (ruxolitinib), there is much more interests in combinations to develop other agents. There now is a myeloproliferative consortium, USA sites collaborating with EU sites, and the European Leukemia Net, focused on myeloproliferative neoplasms. There are more initiatives now to bring patients globally together, to allow their participation in broad clinical trials aimed to improve their quality of life. The molecular aspects of testing is, however, still at the beginning. It is not invaluable in many cases, like it is in acute lymphocytic leukemia (ALL). For myeloproliferative neoplasms knowledge on molecular / genetic markers is, however, important in determining when to do the transplant in myelofibrosis. This is a rapidly moving area. A transplant is the only possible cure for myelofibrosis and by default we are always waiting for patients to be very advanced in the disease, and then they may be too sick or have no donor. As a result, transplants now only happen for 10% of myelofibrosis patients. If we had a way to determine the high risk group for rapid myelofibrosis progression, we would recommend transplantation sooner, rather than later.
Dr. Marcucci briefly summarizes the discussion and congratulates Dr. Verstovsek with his great study.