What You Should Know
- New targeted therapies such as the IDH inhibitor vorasidenib are changing treatment for some low-grade glioma patients, offering a less toxic alternative to traditional chemotherapy and significantly extending progression-free survival.
- Dr. Michael Youssef of Houston Methodist says IDH inhibitors provide a way to target the genetic drivers of certain gliomas with relatively few side effects, though patients still require regular monitoring for liver enzyme elevations.
- Cancer treatment costs can create significant financial strain, but patients should not skip medications or delay care because of copays.
- Youssef encourages patients to ask about financial counselors, grants, and assistance programs that can help cover treatment-related expenses.
New targeted therapies are offering some patients a way to slow tumor growth with fewer side effects than traditional treatments, creating new opportunities but also raising practical questions about access, insurance coverage, and cost.
Read MoreA New Era of Targeted Treatment for Glioma
Gliomas are tumors that arise from glial cells, the supportive cells that help maintain normal brain and spinal cord function. Treatment recommendations typically depend on factors such as tumor grade, location, genetics, and the patient’s overall health.WATCH: Molecular Testing for IDH Inhibitors in Glioma Patients
One of the most significant recent advances involves therapies that target mutations in the isocitrate dehydrogenase (IDH) genes. IDH mutations occur in many low-grade gliomas and are believed to drive tumor growth.
Vorasidenib: A Newer Option for Some Patients
One newer targeted therapy is vorasidenib, approved for certain patients with grade 2 gliomas that carry an IDH mutation.
Unlike chemotherapy, which broadly attacks rapidly dividing cells, vorasidenib targets the abnormal IDH pathway that helps fuel tumor growth.
Historically, many patients with low-grade gliomas underwent active surveillance until their disease progressed enough to warrant surgery, radiation, or chemotherapy. Vorasidenib offers an opportunity to delay disease progression while potentially postponing the need for more aggressive treatments.
WATCH: Seven Years After Glioma Diagnosis, Targeted Therapy Vorasidenib Gave Sarah Geary A New Start
Updated data from the INDIGO clinical trial, presented at the American Society of Clinical Oncology (ASCO) annual meeting in 2026, showed a median progression-free survival of 44.1 months for patients treated with vorasidenib, compared with 11 months among patients originally assigned to placebo.
Patients should ask their care team whether molecular testing was performed on their tumor and whether an IDH mutation was identified, as this information may directly affect eligibility for targeted therapies.
What Are the Side Effects?
Targeted therapies are generally considered less toxic than traditional chemotherapy, but they are not completely free of side effects.
Commonly reported side effects associated with vorasidenib include:
- Fatigue
- Elevated liver enzymes
- Nausea
- Headache
- Diarrhea
Dr. Youssef says liver function monitoring is especially important.
“It’s a 40 milligram tablet taken once a day every single day. From a side effect profile, it’s fairly benign. The most common side effect is an elevation in the liver enzyme, so labs are checked frequently upfront and then on a regular schedule when patients are getting MRIs,” he says.
Paying for Treatment: Why Insurance Matters
While treatment decisions often focus on effectiveness and side effects, financial considerations can quickly enter the conversation.
“When we talk about the financial aspect of treatment, it all really comes down to insurance. That’s the backbone of our treatment. These things, radiation, surgery, can cost hundreds of thousands of dollars, and making sure you have insurance coverage and making sure you’re going somewhere that your insurance is accepted is key,” Dr. Youssef says.
Cancer therapies, imaging scans, surgery, radiation treatmshoweents, specialist visits, and prescription medications can generate significant out-of-pocket expenses, even for insured patients. Experts increasingly refer to this burden as financial toxicity, a term describing both the direct financial strain and emotional stress caused by cancer-related costs.
Financial Help May Be Available
Many patients are unaware that assistance programs exist to help cover treatment-related expenses.
“We have financial counselors that are typically available at almost every cancer center who can help discuss these issues and find grants and find assistance.”
Dr. Youssef encourages patients to speak up if treatment costs become a concern, especially when facing prescription copays.
“One area that’s kind of overlooked is grants for treatment. Those copays for chemotherapy can add up pretty quickly.”
“When they get a copay, and it’s $500 or $300 or even $100, don’t try to stretch your money if you can’t afford it. Ask if there’s an assistance program available; ask if there’s a grant available because there most likely is.”
Resources may include:
- Pharmaceutical company patient assistance programs
- Copay assistance foundations
- Hospital-based financial aid programs
- Nonprofit advocacy organizations
- State and federal programs such as Medicare and Medicaid
According to Sara Goldberger, president of the Association of Oncology Social Work, oncology social workers can help patients identify programs they may qualify for and connect them with financial resources.
Steps to Prepare Financially
In addition to seeking assistance programs, financial experts recommend taking stock of your finances soon after diagnosis. This may include:
- Calculating deductibles and expected out-of-pocket medical costs
- Reviewing emergency savings, health savings accounts, and flexible spending accounts
- Reducing discretionary expenses where possible
- Reviewing optional payroll deductions and employee benefits with human resources
Patients may also encounter unexpected costs beyond treatment itself, including transportation, childcare, lost income, lodging, and hospital parking fees.
New targeted therapies such as vorasidenib are giving some glioma patients an effective treatment option that may delay disease progression while avoiding many of the side effects associated with traditional chemotherapy. But understanding whether you’re eligible, navigating insurance coverage, and managing treatment costs are all important parts of the conversation.
Questions Patients Should Ask Their Care Team
- Was my tumor tested for an IDH mutation?
- Am I eligible for targeted therapies such as vorasidenib?
- What financial assistance programs are available to help cover treatment costs?
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