PV at ASCO 2026 / Polycythemia Vera 06/09/2026

Optimizing Ropeginterferon Use in Polycythemia Vera

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Key Points

  • Ropeginterferon alfa-2b-njft demonstrates improved tolerability compared with historical interferon formulations.
  • Common adverse events include mild cytopenias, liver enzyme elevations, and occasional autoimmune manifestations.
  • Increasing clinical experience supports the use of ropeginterferon across a broader age range, including selected older adults.
  • Individualized dose escalation and interval adjustment can optimize efficacy and quality of life.

In a recent Clinical Insights discussion on evolving treatment approaches in polycythemia vera (PV) — coinciding with the 2026 American Society of Clinical Oncology (ASCO) Annual Meeting in Chicago — Oncology Brothers podcast cohosts Rahul Gosain, MD, MBA, of Wilmot Cancer Institute, and Rohit Gosain, MD, of Roswell Park Comprehensive Cancer Center, welcomed Aaron Gerds, MD, of Cleveland Clinic; Anthony Hunter, MD, of Winship Cancer Institute of Emory University; and Anand Patel, MD, of the University of Chicago. 

Dr. Hunter highlighted that modern formulations demonstrate markedly improved tolerability compared with earlier interferons, aided by extended dosing intervals and steadier drug exposure. As a result, flu-like symptoms are less common — most patients report only brief fatigue or mild headaches — and discontinuation due to adverse effects is becoming uncommon in practice.

The most frequently encountered adverse effects include mild cytopenias and liver function test abnormalities. Monitoring hepatic enzymes remains important in routine management, according to Dr. Gerds, who noted that transient elevations are relatively common and can often be managed through temporary dose adjustments. Clinicians should also remain vigilant for autoimmune manifestations, including dry eyes, dry mouth, rash, and exacerbation of preexisting autoimmune disorders. 

Although psychiatric concerns have historically been associated with interferon therapy, the panel noted that these complications appear less prominent with ropeginterferon than with earlier formulations.

Patient selection has expanded considerably as experience with the drug has grown. Although interferons were once reserved primarily for younger individuals, clinicians increasingly report successful use in older adults. Dr. Gerds described initiating ropeginterferon in an 80-year-old patient whose disease was inadequately controlled with hydroxyurea, emphasizing that chronological age alone should not preclude treatment consideration. Instead, therapeutic decisions should incorporate disease characteristics, treatment goals, comorbidities, and patient preferences.

Dosing strategies continue to evolve in clinical practice. Dr. Patel described a cautious titration approach that begins with lower doses and gradually escalates to achieve stable hematologic control. Once patients demonstrate sustained responses and acceptable tolerability, dosing intervals may be extended from every 2 weeks to every 4 weeks. Quality-of-life considerations frequently influence this transition, particularly for patients experiencing mild symptoms after treatment.