TARGET AUDIENCE
This activity is intended for medical oncologists, hematologist-oncologists, hematology-oncology fellows, oncology nurses and other practitioners involved in the care of patients with myelofibrosis.

OVERVIEW OF ACTIVITY
Myelofibrosis is a myeloproliferative neoplasm that is relatively rare and for which no precise incidence has been defined, but it is estimated that approximately 16,000 to 18,500 patients are currently affected by this disease in the United States. Myelofibrosis is characterized by abnormal red and white blood cell and platelet counts, splenomegaly and a variety of constitutional symptoms that are believed to be the result of both splenomegaly and proinflammatory cytokines. Survival may range from 2 to more than 10 years depending on clinical and genetic abnormalities.

Therapeutic options for myelofibrosis are few and provide limited benefit, with the exception of allogeneic stem cell transplantation, which may be curative but for which few patients are eligible. The JAK2 inhibitor ruxolitinib has been shown to result in reduced splenomegaly and improvement in symptoms and overall survival in patients with symptomatic myelofibrosis. Ruxolitinib is the first FDA-approved systemic therapy for myelofibrosis. However, because of the infrequency of myelofibrosis many community oncologists have limited knowledge of this disease and its management, particularly with newly emerging agents.

To bridge the gap between research and patient care, this CME activity will use the perspectives of clinical investigators on key management challenges and controversies in myelofibrosis to assist medical oncologists, hematologist-oncologists, hematology-oncology fellows and other cancer clinicians in the formulation of up-to-date and appropriate treatment strategies.

LEARNING OBJECTIVES

• Offer ruxolitinib to appropriately selected patients with myelofibrosis, regardless of JAK2 V617F mutation status, with the recognition that JAK-STAT signaling is overactivated in all patients with this disease.
• Determine the appropriate use of ruxolitinib in patients with myelofibrosis with progressive splenomegaly despite stability or a decrease in symptom burden.
• Assess the clinical impact of thrombocytopenia and/or degree of anemia on dosing of ruxolitinib.
• Develop an approach to the discontinuation of ruxolitinib in patients who have experienced increased splenomegaly and/or a decline in symptom control.
• Determine the current clinical role of cytogenetic and FISH abnormalities in the diagnosis, prognosis and treatment decision-making for patients with suspected and known myelofibrosis.

ACCREDITATION STATEMENT
Research To Practice is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

CME credit is no longer available for this issue

CREDIT DESIGNATION STATEMENT

CME credit is no longer available for this issue

HOW TO USE THIS CME ACTIVITY
This CME activity consists of text and slide components. The participant should read the commentary and review the slide sets.

CME credit is no longer available for this issue

CONTENT VALIDATION AND DISCLOSURES
Research To Practice (RTP) is committed to providing its participants with high-quality, unbiased and state-of-the-art education. We assess potential conflicts of interest with faculty, planners and managers of CME activities. Real or apparent conflicts of interest are identified and resolved through a conflict of interest resolution process. In addition, all activity content is reviewed by both a member of the RTP scientific staff and an external, independent physician reviewer for fair balance, scientific objectivity of studies referenced and patient care recommendations.

FACULTY — The following faculty (and their spouses/partners) reported real or apparent conflicts of interest, which have been resolved through a conflict of interest resolution process:

Francisco Cervantes, MD, PhD
Hospital Clínic
University of Barcelona
Barcelona, Spain

Advisory Committee: Celgene Corporation, Novartis Pharmaceuticals Corporation, Pfizer Inc, Sanofi, Teva Oncology; Speakers Bureau: Bristol-Myers Squibb Company, Novartis Pharmaceuticals Corporation.

Jorge E Cortes, MD
The University of Texas MD Anderson Cancer Center
Houston, Texas

Advisory Committee: Boehringer Ingelheim Pharmaceuticals Inc; Consulting Agreements: Bristol-Myers Squibb Company, Genentech BioOncology, Lilly, Novartis Pharmaceuticals Corporation, Pfizer Inc, Sanofi; Paid Research: AstraZeneca Pharmaceuticals LP, Bristol-Myers Squibb Company, Celgene Corporation, Genzyme Corporation, Novartis Pharmaceuticals Corporation, Pfizer Inc, Sanofi.

Jason Gotlib, MD, MS
Stanford Cancer Institute
Stanford, California

Advisory Committee and Contracted Research: Gilead Sciences Inc, Incyte Corporation, Novartis Pharmaceuticals Corporation, Sanofi; Travel Support: Incyte Corporation, Novartis Pharmaceuticals Corporation.

Elias Jabbour, MD
The University of Texas MD Anderson Cancer Center
Houston, Texas

Consulting Agreements: Bristol-Myers Squibb Company, Novartis Pharmaceuticals Corporation, Pfizer Inc.

Hagop M Kantarjian, MD
The University of Texas MD Anderson Cancer Center
Houston, Texas

Consulting Agreement: Novartis Pharmaceuticals Corporation; Paid Research: ARIAD Pharmaceuticals Inc, Bristol-Myers Squibb Company, Novartis Pharmaceuticals Corporation, Pfizer Inc.

John O Mascarenhas, MD
Mount Sinai School of Medicine
New York, New York

Consulting Agreements: Incyte Corporation; Contracted Research: Celgene Corporation, Genzyme Corporation, Incyte Corporation, Novartis Pharmaceuticals Corporation.

Ruben A Mesa, MD
Mayo Clinic
Scottsdale, Arizona

Contracted Research: Celgene Corporation, Genentech BioOncology, Lilly, Sanofi.

Jerry L Spivak, MD
Johns Hopkins University School of Medicine
Baltimore, Maryland

Consulting Agreements: Celgene Corporation, Merck, Novartis Pharmaceuticals Corporation.

David P Steensma, MD
Dana-Farber Cancer Institute
Boston, Massachusetts

Advisory Committee: Astex Pharmaceuticals, Boehringer Ingelheim Pharmaceuticals Inc, Incyte Corporation, Novartis Pharmaceuticals Corporation; Consulting Agreements: Amgen Inc, Celgene Corporation.

Moshe Talpaz, MD
University of Michigan Hospital and Health Systems
Ann Arbor, Michigan

Advisory Committee: ARIAD Pharmaceuticals Inc, Novartis Pharmaceuticals Corporation, Pfizer Inc, Sanofi; Consulting Agreement: Pfizer Inc; Contracted Research: Abbott Laboratories, ARIAD Pharmaceuticals Inc, Bristol-Myers Squibb Company, Celgene Corporation, Genentech BioOncology, Millennium: The Takeda Oncology Company, Novartis Pharmaceuticals Corporation, Onyx Pharmaceuticals Inc, Pfizer Inc, Sanofi.

Alessandro M Vannucchi, MD
University of Florence
Florence, Italy

Advisory Committee: Novartis Pharmaceuticals Corporation.

Srdan Verstovsek, MD, PhD
The University of Texas MD Anderson Cancer Center
Houston, Texas

Contracted Research: AstraZeneca Pharmaceuticals LP, Bristol-Myers Squibb Company, Celgene Corporation, Geron, Gilead Sciences Inc, Incyte Corporation, Infinity Pharmaceuticals Inc, Lilly, Novartis Pharmaceuticals Corporation, NS Pharma Inc, Promedior Inc, Roche Laboratories Inc, Seattle Genetics, YM BioSciences Inc.

EDITOR — Dr Love is president and CEO of Research To Practice, which receives funds in the form of educational grants to develop CME/CNE activities from the following commercial interests: AbbVie Inc, Amgen Inc, Astellas, AstraZeneca Pharmaceuticals LP, Aveo Pharmaceuticals, Bayer HealthCare Pharmaceuticals, Biodesix Inc, Biogen Idec, Boehringer Ingelheim Pharmaceuticals Inc, Bristol-Myers Squibb Company, Celgene Corporation, Daiichi Sankyo Inc, Dendreon Corporation, Eisai Inc, Exelixis Inc, Genentech BioOncology, Genomic Health Inc, Gilead Sciences Inc, Incyte Corporation, Lilly, Medivation Inc, Merck, Millennium: The Takeda Oncology Company, Novartis Pharmaceuticals Corporation, Novocure, Onyx Pharmaceuticals Inc, Prometheus Laboratories Inc, Regeneron Pharmaceuticals, Sanofi, Seattle Genetics, Spectrum Pharmaceuticals Inc, Teva Oncology and VisionGate Inc.

RESEARCH TO PRACTICE STAFF AND EXTERNAL REVIEWERS — The scientific staff and reviewers for Research To Practice have no real or apparent conflicts of interest to disclose.

This educational activity contains discussion of published and/or investigational uses of agents that are not indicated by the Food and Drug Administration. Research To Practice does not recommend the use of any agent outside of the labeled indications. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications and warnings. The opinions expressed are those of the presenters and are not to be construed as those of the publisher or grantor.

This activity is supported by an educational grant from Incyte Corporation.

Hardware/Software Requirements:
A high-speed Internet connection
A monitor set to 1280 x 1024 pixels or more
Internet Explorer 7 or later, Firefox 3.0 or later, Chrome, Safari 3.0 or later
Adobe Flash Player 10.2 plug-in or later
Adobe Acrobat Reader
(Optional) Sound card and speakers for audio

Last review date: July 2014
Expiration date: July 2015