JAK2 inhibitors for myelofibrosis: why are they effective in patients with and without JAK2V617F mutation?

Anticancer Agents Med Chem. 2012 Nov;12(9):1098-109. doi: 10.2174/187152012803529727.

Abstract

An activating mutation (V617F) in the pseudokinase domain of the Janus kinase (JAK)-2 tyrosine kinase has been described in 90% of patients with polycythemia vera (PV) and 50% of patients with essential thrombocythemia (ET) and primary myelofibrosis (MF). The discovery of JAK2V617F stirred the development of JAK2 inhibitors for treatment of patients with MF, ET and PV. Similar to other tyrosine kinase (TK) inhibitors in current use, JAK2 inhibitors target the adenosine triphosphate (ATP) binding site at the TK domain and not the pseudokinase domain, thus affecting both mutated and wild-type kinases. In fact, clinical trials of these compounds have demonstrated improvements in constitutional symptoms and splenomegaly in patients with both mutated and wild-type JAK2 MF. It is believed that these drugs may act not only through inhibition of neoplastic cell proliferation, but also by downregulating signaling through proinflammatory cytokine receptors. In this article, we review the current state of JAK2 inhibitors and discuss why these drugs could be a valuable addition to the treatment armamentarium for patients with and without the JAK2V617F mutation.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Animals
  • Benzamides / therapeutic use
  • Benzamides / toxicity
  • Cytokines / immunology
  • Humans
  • Imidazoles / therapeutic use
  • Imidazoles / toxicity
  • Janus Kinase 2 / antagonists & inhibitors*
  • Janus Kinase 2 / chemistry
  • Janus Kinase 2 / genetics
  • Janus Kinase 2 / immunology
  • Nitriles
  • Point Mutation*
  • Primary Myelofibrosis / drug therapy*
  • Primary Myelofibrosis / enzymology*
  • Primary Myelofibrosis / genetics
  • Primary Myelofibrosis / immunology
  • Protein Kinase Inhibitors / therapeutic use*
  • Protein Kinase Inhibitors / toxicity
  • Pyrazoles / therapeutic use
  • Pyrazoles / toxicity
  • Pyridazines / therapeutic use
  • Pyridazines / toxicity
  • Pyrimidines / therapeutic use
  • Pyrimidines / toxicity
  • Pyrrolidines / therapeutic use
  • Pyrrolidines / toxicity
  • Sulfonamides / therapeutic use
  • Sulfonamides / toxicity

Substances

  • Benzamides
  • Cytokines
  • Imidazoles
  • LY2784544
  • Nitriles
  • Protein Kinase Inhibitors
  • Pyrazoles
  • Pyridazines
  • Pyrimidines
  • Pyrrolidines
  • Sulfonamides
  • fedratinib
  • N-(cyanomethyl)-4-(2-((4-(4-morpholinyl)phenyl)amino)-4-pyrimidinyl)benzamide
  • ruxolitinib
  • Janus Kinase 2