Reference Detail

Ref Type

Journal Article

PMID

(38496920)

Authors

Peters KB, Alford C, Heltemes A, Savelli A, Landi DB, Broadwater G, Desjardins A, Johnson MO, Low JT, Khasraw M, Ashley DM, Friedman HS, Patel MP

Title

Use, access, and initial outcomes of off-label ivosidenib in patients with IDH1 mutant glioma.

Journal	Vol	Issue	Date	Pages	Journal Short Title
Neuro-oncology practice	11	2	2024 Apr	199-204	Neurooncol Pract

URL

Abstract Text

Isocitrate dehydrogenase (IDH) is commonly mutated (mIDH) in gliomas, and this mutant enzyme produces the oncometabolite 2-hydroxyglutarate (2HG). 2HG promotes gliomagenesis and is implicated in epileptogenesis. Ivosidenib (IVO), a small molecule oral mIDH1 inhibitor, is FDA-approved for mIDH1 newly diagnosed and relapsed/refractory acute myeloid leukemia. Moreover, IVO has efficacy in clinical trials for recurrent mIDH1 gliomas. Given the lack of targeted treatments for gliomas, we initiated off-label IVO for mIDH glioma patients in October 2020.Retrospectively, we sought to assess early outcomes in our patients and describe their experience on IVO from October 2020 through February 2022. Our objective was to report on the following variables of off-label use of IVO: radiographic response, seizure control, tolerability, and access to the medication. All patients initially received single-agent IVO dosed at 500 mg orally once daily.The cohort age range was 21-74 years. Tumor types included astrocytoma (n = 14) and oligodendroglioma (n = 16), with most being grade 2 (n = 21). The best radiographic response in nonenhancing disease (n = 22) was 12 stable diseases, 5 minor responses, 3 partial responses, and 2 progressive diseases. Seizure frequency was stable to improved for most patients (70%, n = 21). IVO was well-tolerated, with the most common toxicities being diarrhea, elevated creatine kinase, and QTc interval prolongation. Most patients (66.7%, n = 20) received drugs via the patient assistance program, with insurance initially covering a third of patients and with ongoing use, later covering 60%.Targeted therapies like IVO are options for mIDH glioma patients and can provide positive oncologic and neurological outcomes.

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Molecular Profile	Treatment Approach

Gene Name	Source	Synonyms	Protein Domains	Gene Description	Gene Role

Therapy Name	Drugs	Efficacy Evidence	Clinical Trials

Drug Name	Trade Name	Synonyms	Drug Classes	Drug Description

Gene	Variant	Impact	Protein Effect	Variant Description	Associated with drug Resistance

Molecular Profile	Indication/Tumor Type	Response Type	Therapy Name	Approval Status	Evidence Type	Efficacy Evidence	References
IDH1 act mut	high grade glioma	predicted - sensitive	Ivosidenib	Clinical Study	Actionable	In a retrospective analysis, Tibsovo (ivosidenib) treatment was well tolerated in patients with glioma harboring an IDH1 mutation, and resulted in a partial response in 13.6% (3/22), minor response in 22.7% (5/22), and stable disease in 54.5% (12/22) of patients with nonenhancing disease, and stable disease in 62.5% (5/8) of patients with enhancing disease (PMID: 38496920).	38496920
IDH1 act mut	low grade glioma	predicted - sensitive	Ivosidenib	Clinical Study	Actionable	In a retrospective analysis, Tibsovo (ivosidenib) treatment was well tolerated in patients with glioma harboring an IDH1 mutation, and resulted in a partial response in 13.6% (3/22), minor response in 22.7% (5/22), and stable disease in 54.5% (12/22) of patients with nonenhancing disease, and stable disease in 62.5% (5/8) of patients with enhancing disease (PMID: 38496920).	38496920