Ruxolitinib is a JAK1/2 inhibitor that is effective in managing symptoms and splenomegaly related to myelofibrosis (MF). Unfortunately, many patients must discontinue ruxolitinib, at which time treatment options are not well defined. In this study, we investigated salvage treatment options and clinical outcomes among MF patients who received and discontinued ruxolitinib outside the context of a clinical trial. Among 145 patients who received ruxolitinib, 23 died while on treatment, 58 remained on treatment at time of analysis, leaving 64 people available for analysis. Development of cytopenias was the most common reason for discontinuation (38%) after median treatment time of 3.8 months (mo). The majority of patients received some form of salvage therapy after ruxolitinib discontinuation (n = 42; 66%), with allogeneic hematopoietic stem cell transplant (alloHSCT) (n = 17), being most commonly employed. Lenalidomide, thalidomide, hydroxyurea, interferon, and danazol were used with similar frequency. The response rate to salvage treatment was 26% (8 responses) and responses were most often seen with lenalidomide or thalidomide. Improved outcomes were observed in patients who underwent alloHSCT or received salvage therapy compared to those who did not receive additional therapy. Median overall survival (OS) after ruxolitinib discontinuation was 13 months. These findings show that salvage therapy can provide clinical responses after ruxolitinib discontinuation; however, these responses are rare and outcomes in this patient population are poor. This represents an area of unmet clinical need in MF.
There is a perception that tamoxifen causes weight gain in breast cancer patients. The purpose of this research study was to determine if weight gain is associated with tamoxifen therapy and to observe the impact of weight gain on recurrence and survival. Prognostic indicators, changes in weight, and disease status from diagnosis to the end of treatment were studied in 200 consecutive Stage I and II breast cancer patients, not receiving systemic chemotherapy, admitted from 1986 to the present, with observation periods ranging from 3-5 years. A mean weight gain of 1.2 Kgs was seen in all patients; however, weight gain was not significantly different for those receiving tamoxifen vs. those not receiving tamoxifen, (P = 0.66, CI 95% for the difference -1.8 Kgs to +1.2 Kgs). Weight gain during treatment with tamoxifen was not correlated with treatment duration or with recurrence or survival. Age at diagnosis was positively correlated to weight gain in all groups. Our data failed to show that tamoxifen is associated with weight gain. The moderate weight gain observed in this patient population is comparable to the general aging disease-free population and may no be treatment-related. These findings may help to alleviate some concerns of both physicians and patients when tamoxifen is the drug of choice for adjuvant therapy.
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