Dr Kremyanskaya on the Use of Cytoreductive Measures in PV and ET

Marina Kremyanskaya, MD, PhD, assistant professor, medicine, hematology, and medical oncology, Icahn School of Medicine at Mount Sinai; medical director, inpatient oncology unit, The Mount Sinai Hospital, discusses disease and patient characteristics that influence the choice between hydroxyurea and interferon therapy for patients with polycythemia vera (PV) or essential thrombocythemia (ET).

Typically, both hydroxyurea and interferons are effective cytoreductive measures in patients with PV or ET, Kremyanskaya says. During individual patient assessment, clinicians consider factors such as comorbidities, age, and therapeutic goals, Kremyanskaya explains. For instance, hydroxyurea is often the optimal treatment option in older patients with newly diagnosed, high-risk disease requiring cytoreductive therapy, Kremyanskaya notes. The favorable characteristics of this agent include its limited toxicity profile that leads to high tolerability, as well as the ease of tailoring the dosage of hydroxyurea according to individual patient needs, according to Kremyanskaya. Although hydroxyurea is not universally effective, it often serves as a prudent initial therapeutic approach, Kremyanskaya emphasizes.

Conversely, younger patients who are concerned about issues such as disease progression and infertility may find interferons to be a more suitable treatment option, Kremyanskaya says. Interferons are hypothesized to have disease-modifying effects in both PV and ET. Although definitive evidence of this ability is still emerging, many oncologists still consider interferons to be a viable therapeutic avenue for younger patients, Kremyanskaya explains.

In the future, patients with chronic myeloproliferative neoplasms need more effective therapies, Kremyanskaya emphasizes. Although PV and ET are commonly considered earlier-stage malignancies, they are associated with high morbidity, mortality, and symptom burden, Kremyanskaya notes. Improved treatment approaches for these patients, with a focus on disease modification, may stop disease progression in many patients and could lead to cures, Kremyanskaya concludes.