Translating SENTRY Data into Clinical Practice / Myelofibrosis 08/19/2026

Ep. 1: The JAK Inhibitor Paradigm and Unmet Needs in Myelofibrosis

Professional portrait of a man in a suit and tie, wearing glasses, smiling confidently against a neutral background. Nikolai Podoltsev, MD, PhD Research scientist in a laboratory setting focusing on oncological advancements and cancer research at OncUpdates. Raajit Rampal, MD, PhD Smiling professional man in a black vest with a blue shirt and red tie, standing indoors with a blurred background. Srinivas Tantravahi, MBBS, MRCP Professional portrait of a man in a dark suit and white shirt against a gray background, suitable for medical or healthcare-related content. Pankit Vachhani, MD Smiling man with beard wearing a white shirt, professional headshot, suitable for oncology or cancer research content, emphasizing healthcare and medical expertise. Rahul Gosain, MD, MBA Oncologist smiling in white coat, highlighting cancer research and treatment expertise, with a bow tie, in a bright medical setting. Rohit Gosain, MD

Key Points

  • Treatment of myelofibrosis largely centers around four approved Janus kinase (JAK) inhibitors: ruxolitinib, fedratinib, pacritinib, and momelotinib.
  • JAK inhibitors are not disease-modifying therapies, and clinical trials seek to improve outcomes for patients with myelofibrosis through novel agents and combinations.

JAK Inhibitors in Myelofibrosis

Rahul Gosain, MD, MBA, of Wilmot Cancer Institute, and Rohit Gosain, MD, of Roswell Park Comprehensive Cancer Center, cohosts of the Oncology Brothers podcast, led a panel discussion on the treatment paradigm for myelofibrosis and the impact of the SENTRY trial. As part of the discussion, Nikolai Podoltsev, MD, PhD, of Yale School of Medicine, and Srinivas Tantravahi, MBBS, MRCP, of Huntsman Cancer Institute at the University of Utah, reviewed the treatment options for myelofibrosis and described unmet needs in the field.

Currently, the primary treatment for myelofibrosis is JAK inhibitor therapy, which helps reduce spleen volume and manage symptom burden. To date, the FDA has approved four JAK inhibitors: ruxolitinib in 2011, fedratinib in 2019, pacritinib in 2022, and momelotinib in 2023. Most patients still receive frontline ruxolitinib, but pacritinib and momelotinib are recommended for patients with thrombocytopenia and anemia, respectively, Dr. Podoltsev said. Outside of JAK inhibitors, allogeneic stem cell transplant is a potentially curative option for myelofibrosis and often pursued in high-risk or highly symptomatic patients. 

Despite their importance, JAK inhibitors have limitations as the primary systemic therapy for patients with myelofibrosis. Chiefly, JAK inhibitors do not reverse fibrosis in the bone marrow or alter the underlying disease biology, and many patients do not respond to treatment. In addition, while newer JAK inhibitors can improve some cytopenias, patients with severe cytopenias remain a challenge to treat, Dr. Tantravahi said. To address these needs, several trials are investigating novel agents and combinations with JAK inhibitors.