In August 2026, the FDA approved ropeginterferon alfa-2b-njft (BESREMi) as a second-line therapy for essential thrombocythemia. Approaches combining ropeginterferon alfa with JAK inhibitors and agents targeting mutated calreticulin remain under investigation, according to Ruben Mesa, MD, FACP.
Mesa, president of Advocate Health’s Cancer National Service Line and executive director of the Atrium Health Wake Forest Baptist Comprehensive Cancer Center, as well as principal investigator of the SURPASS-ET trial, spoke with CancerNetwork® following the approval. He discussed whether disease-modifying or potentially curative strategies are within reach for essential thrombocythemia, or whether durable hematologic and thromboembolic control remains the realistic ceiling. Additionally, he described how future work may determine whether ropeginterferon alfa has a role in earlier phases of essential thrombocythemia.
Transcript:
CancerNetwork: Looking ahead, do you see a path toward disease-modifying or potentially curative strategies in essential thrombocythemia building on what’s been learned here, or is durable hematologic and thromboembolic control still the realistic ceiling for this disease?
Mesa: Patients having a good response to ropeginterferon alfa will probably have some degree of disease modification. I think our ability to measure that is still partial. I think there are some individuals who have had tremendous responses to ropeginterferon that we’ll see over time, as we’ve learned in polycythemia vera, where their variant allele frequency might vanish, and there’s evidence of deep disease control. We will achieve some of that, and the more we learn how to best monitor disease progression and disease modification, [the more] we’ll be able to quantify that to a greater degree.
I envision that ropeginterferon may also play an important role in future combination approaches. There are a variety of different approaches [that are] still investigational in essential thrombocythemia, [like] specific agents targeting mutated calreticulin, for example. There’s evolution of JAK inhibitors that could potentially play a role. There’s good reason to think there could be combination approaches; there have been combination approaches in investigational settings of long-acting interferons with JAK inhibitors that have shown some synergistic properties. I suspect that, already, ropeginterferon can be partially disease-modifying—realizing that impact on an individual patient is still a little difficult to exactly quantify. I envision that will build even further over time as we get [a better] understanding of the biology of the disease, as well as the potential approach with different combinations. The approval right now is in this second-line setting, but I think over time we’ll find whether there’s a role for use in earlier phases of the disease, and if so, whether you alter the trajectory even more by using it that early in the disease course.
Reference
FDA approves PharmaEssentia’s BESREMi® (ropeginterferon alfa-2b-njft) for adults with essential thrombocythemia, a rare blood cancer. News release. PharmaEssentia USA Corporation. August 31, 2026. Accessed September 1, 2026. https://tinyurl.com/bdnt65xx
