Ruxolitinib is demonstrating significant efficacy in treating steroid-refractory chronic graft-versus-host disease (cGVHD), according to updated data from the REACH3 trial reviewed by Stephanie Lee, MD, MPH, in a recent interview with Targeted Oncology.
"The updated results from REACH3 continue to show robust and durable responses in patients with steroid-refractory chronic GVHD," said Dr. Lee, who highlighted the importance of these findings for a patient population with limited treatment options.
REACH3 Trial: Updated Findings
The REACH3 (Ruxolitinib in PatiEnts with RefrACtory Graft-Versus-Host Disease After Allogeneic Stem Cell Transplantation) trial is a pivotal Phase 3 study evaluating ruxolitinib, a JAK1/2 inhibitor, against best available therapy in patients with steroid-refractory cGVHD.
According to Dr. Lee, the trial demonstrated superior overall response rates with ruxolitinib compared to standard therapies. Patients receiving ruxolitinib showed significant improvements in key secondary endpoints, including failure-free survival and symptom burden reduction.
"What's particularly encouraging is the durability of responses we're seeing," Dr. Lee explained. "Many patients maintain their response beyond the primary analysis period, suggesting ruxolitinib may provide long-term disease control."
The safety profile remained consistent with previous reports, with the most common adverse events including thrombocytopenia, anemia, and infections. However, Dr. Lee noted that these were generally manageable with dose modifications and supportive care.
Clinical Implications for cGVHD Management
Chronic GVHD affects approximately 30-70% of patients following allogeneic stem cell transplantation and represents a significant cause of morbidity and mortality. First-line treatment typically involves corticosteroids, but approximately 50% of patients develop steroid-refractory disease.
"Before the approval of ruxolitinib, options for steroid-refractory patients were limited and based largely on low-quality evidence," Dr. Lee said. "The REACH3 data provides clinicians with a more effective, evidence-based approach for these challenging cases."
The trial results have already influenced clinical practice, with ruxolitinib receiving FDA approval for steroid-refractory cGVHD in 2021. Dr. Lee emphasized that early intervention with ruxolitinib after steroid failure may lead to better outcomes by preventing irreversible organ damage from ongoing inflammation.
Personalized JAK Inhibitor Selection
The success of ruxolitinib in cGVHD builds upon its established efficacy in myeloproliferative neoplasms, particularly myelofibrosis. Dr. Lee discussed how clinicians are increasingly personalizing JAK inhibitor selection based on patient characteristics and molecular profiles.
"We're learning that patient-specific factors such as platelet count, anemia status, and specific molecular mutations may influence the choice between available JAK inhibitors," she explained. "This personalized approach is critical for optimizing outcomes."
For cGVHD specifically, factors such as organ involvement patterns, prior therapies, and comorbidities may influence treatment decisions. Dr. Lee noted that ongoing research is investigating biomarkers that might predict response to ruxolitinib and other agents.
Treatment Sequencing Considerations
The interview also addressed important considerations regarding treatment sequencing in cGVHD. While ruxolitinib has shown efficacy as second-line therapy, questions remain about optimal sequencing with other agents.
"We're still determining the ideal sequence of therapies after steroid failure," Dr. Lee acknowledged. "Some patients may benefit from ruxolitinib as immediate second-line therapy, while others might be better served by alternative approaches based on their specific manifestations."
Dr. Lee highlighted ongoing trials evaluating ruxolitinib in combination with other agents, as well as studies investigating its use earlier in the disease course, potentially as a steroid-sparing agent in first-line treatment.
Future Directions
Looking ahead, Dr. Lee identified several key areas for future research in cGVHD management. These include identifying predictive biomarkers of response, optimizing dosing strategies to minimize toxicity while maintaining efficacy, and exploring novel combination approaches.
"The success of ruxolitinib has energized the field, and we're now seeing increased interest in developing targeted therapies for cGVHD," she said. "The goal is to move beyond broad immunosuppression toward more precise interventions that address the underlying pathophysiology."
Dr. Lee emphasized that while the REACH3 results represent a significant advance, cGVHD remains a complex, heterogeneous condition requiring multidisciplinary management and individualized treatment approaches.
"Ruxolitinib provides an important new option, but it's not a one-size-fits-all solution," she concluded. "Our challenge now is to determine which patients will benefit most from this therapy and how to integrate it optimally into our treatment algorithms."
