PV at ASCO 2026 / Polycythemia Vera 06/11/2026

Treatment Selection and Future Directions in Polycythemia Vera

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Key Points

  • Ropeginterferon alfa-2b-njft is increasingly recognized as an important frontline cytoreductive therapy for many patients with polycythemia vera (PV).
  • Hydroxyurea remains an important treatment option, particularly for patients who prefer oral therapy.
  • Ruxolitinib is often used after hydroxyurea or ropeginterferon failure, especially in symptomatic patients.
  • Rusfertide may serve as an adjunctive therapy focused on reducing phlebotomy requirements rather than disease modification.

In a Clinical Insights session 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, were joined by 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, to discuss evolving treatment approaches in PV.

The panel discussed ropeginterferon as an increasingly favored frontline option in appropriate patients, especially those with low-risk disease requiring cytoreduction. Dr. Gerds referenced NCCN Guidelines supporting its use in this setting, noting growing confidence in the treatment’s ability to achieve durable hematologic responses while also addressing disease biology. 

For higher-risk patients, treatment decisions often involve individualized discussions comparing hydroxyurea and ropeginterferon. Factors such as patient preference, comorbidities, treatment goals, and anticipated treatment duration influence therapy selection. Both Dr. Gerds and Dr. Patel emphasized that ropeginterferon should be considered an important frontline option capable of delivering durable disease control, not just viewed as a second-line therapy. 

Ruxolitinib continues to occupy a key role in later-line management, particularly among patients with symptomatic splenomegaly, persistent constitutional symptoms, or inadequate responses to hydroxyurea. Although frontline data remain limited, clinicians described maintaining a relatively low threshold for transitioning appropriate patients to ruxolitinib when symptom burden becomes a dominant clinical concern. The agent offers meaningful symptomatic improvement and remains an important component of the therapeutic armamentarium.

Looking ahead, the panel discussed the potential role of rusfertide as an adjunct therapy rather than a replacement for existing cytoreductive approaches. Because rusfertide primarily reduces phlebotomy requirements without significantly affecting JAK2 allele burden or disease biology, it may complement rather than supplant disease-modifying treatments. 

The panel also acknowledged ongoing uncertainty regarding routine JAK2 monitoring, with most clinicians reserving serial allele burden testing for selected patients, particularly those considering treatment discontinuation after achieving sustained responses.