Dr Kuykendall on Frontline Cytoreductive Therapies in Polycythemia Vera

Andrew Kuykendall, MD, assistant member, Department of Malignant Hematology, Moffitt Cancer Center, discusses frontline cytoreductive treatment options for patients with polycythemia vera.

In the management of polycythemia vera, the choice of treatment with frontline cytoreductive therapies is primarily between pegylated interferon alfa-2a or hydroxyurea, 2 agents that possess distinct characteristics, Kuykendall says. Pegylated interferon alfa-2a is administered subcutaneously and provides long-acting efficacy, whereas hydroxyurea is an oral agent with a shorter duration of action, Kuykendall explains. Additionally, although both agents are relatively well tolerated, their adverse event profiles differ from one another and inform the use of these agents in different patient populations, Kuykendall notes.

For instance, older patients with polycythemia vera typically receive hydroxyurea, whereas younger patients will often receive pegylated interferon alfa-2a, according to Kuykendall. Although both agents are reasonable frontline treatment options for patients with polycythemia vera, the rationales for the use of each agent differs, Kuykendall emphasizes.

A randomized phase 3 trial compared pegylated interferon alfa-2 vs hydroxyurea in patients with polycythemia vera and essential thrombocytopenia. In the patients with polycythemia vera, the 12-month complete response (CR) rates with pegylated interferon alfa-2 and hydroxyurea were 28% and 30%, respectively (P = .80). At 24 months, the CR rates were 25% with pegylated interferon alfa-2 and 17% with hydroxyurea. At 36 months, the CR rates with pegylated interferon alfa-2 and hydroxyurea were 29% and 17%, respectively. Additionally, of the patients who received post-baseline imaging for spleen response, the median spleen reduction was –6% (best response on treatment range, –37% to 54%) with pegylated interferon alfa-2 vs –5% (best response on treatment range, –24% to 17%) with hydroxyurea.

The use of pegylated interferon alfa-2 has increased over the past few years because of ongoing developments with this agent, including the advent of more tolerable formulations and its potential to elicit long-term disease modification, Kuykendall explains. This growing inclination toward using pegylated interferon alfa-2 underscores the ongoing interest in finding polycythemia vera treatments that can do more than simply reduce thrombotic potential for patients, Kuykendall says.

Disclosures: Dr Kuykendall reports honoraria, advisory board participation, and consulting roles with Incyte, AbbVie, GSK, BMS, Imago, CTI Biopharma, Protagonist, PharmaEssentia, Cogent, Blueprint, and Karyopharm; as well as research support from BMS, Novartis, Protagonist, Janssen, Geron, Morphosys, Sierra/GSK, and Blueprint.