Vorasidenib: A 'Game-Changer' For IDH-Mutated Gliomas
- Glioma is a primary brain tumor that originates from the glial cells present in the central nervous system. Recently, a “game-changing” targeted drug called vorasidenib was approved to treat patients with grade 2 glioma with a mutation in the isocitrate dehydrogenase (IDH) protein.
- Vorasidenib is oral, convenient, and taken at home. Some patients are excellent candidates for the drug, especially younger adults with residual or subtly growing IDH-mutant tumors who hope to put off other treatment approaches.
- Patients should also understand that the treatment is a life-long commitment, long-term side effects are not yet known, and there may be a financial burden.
- Glioma patients should ask their doctors about molecular testing to see if an IDH targeted treatment is appropriate.
Doctors called these tumors “low-grade,” but anyone who has lived with one knows that name has never told the full story. These tumors grow slowly, but they grow relentlessly. They often affect younger adults and they disrupt real life through seizures, memory problems, work limitations, and chronic anxiety about what comes next
Read MoreThe Breakthrough Approval
The drug approval was based on promising results from the INDIGO trial, a major international study, published in the New England Journal of Medicine.
The trial focused on patients with grade 2 IDH-mutant gliomas who had already undergone surgery but had not yet received other cancer treatments like radiation or chemotherapy. This made them appropriate candidates for a “watch-and-wait” approach.
Patients were randomly assigned to receive either 40 mg of oral vorasidenib once daily or a matching placebo. The primary goal was to measure progression-free survival (PFS) — how long patients lived without their disease worsening based on imaging — and the key secondary goal was the time to the next anticancer intervention (TTNI).
The results were remarkable, leading the independent monitoring committee to recommend unblinding the trial early due to the clear demonstration of efficacy.
The Key Findings
- Progression-Free Survival: The median PFS for the vorasidenib group was 27.7 months, compared to just 11.1 months for the placebo group. This represents a hazard ratio of 0.39, meaning the risk of disease progression or death was reduced by 61% in the vorasidenib group.
- Delaying Further Treatment: Vorasidenib dramatically delayed the need for subsequent aggressive treatments. The time to the next intervention was significantly improved in the vorasidenib group, delaying the need for therapies like chemotherapy or radiation.
The likelihood of being alive and not requiring further intervention by 24 months was 83.4% in the vorasidenib group, compared to only 27% in the placebo group.
Who Benefits From Vorasidenib?
Vorasidenib is oral, convenient, and taken at home. Some patients are excellent candidates for vorasidenib, especially younger adults with residual or subtly growing IDH-mutant tumors who want to delay radiation because of long-term cognitive concerns.
But patients should also understand that the treatment is a life-long commitment, long-term side effects are not yet known, and there may be a significant financial burden. Factors like emotional readiness, ability to commit to a daily medication, insurance stability, and access to monitoring all matter.
Related: Vorasidenib: Ideal candidates vs. real-world patients
A Welcome New Step In Glioma Care
“Until last year, the mainstay of treatment still was to go through a brain surgery to take out as much as you can,” Dr. Kurz says. “However, in the brain, often these tumors sit in places where they cannot be completely removed because completely removing those tumors would affect neurological function. So patients would come out of the OR with more weakness or more language problems.”
Ever after surgery, Dr. Kurz adds, many of those patients would go on to radiation and chemotherapy, which can both come with serious side effects.
Now that there is a targeted drug, specifically for a subtype of glioma, patients with this specific mutation (IDH) can avoid unnecessary treatments that come with serious risks.
Molecular Testing & Precision Medicine
With molecular testing, doctors are no longer treating gliomas as a one-size-fits-all disease. They now know that a glioma with an IDH mutation, for example, behaves very differently from one without it, and this difference can completely change the approach to treatment.
Gliomas are a diverse group of tumors. Some grow slowly and respond well to certain treatments, while others are more aggressive and require a different approach.
Molecular testing provides doctors with the information to correctly diagnose which type of glioma the patient has and choose the best treatment moving forward.
Make sure to ask your doctor if your tumor has been tested for IDH mutation.
Questions To Ask Your Doctor
If you have been diagnosed with glioma, here are some questions to guide your conversation with your doctor:
- Have I/can I undergo molecular testing?
- What specific mutations will you be testing for in my tumor?
- How will the results of this testing affect my treatment options?
- Am I eligible for any targeted therapies or clinical trials based on my molecular testing results?
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