Vorasidenib and ivosidenib in IDH1-mutant low-grade glioma: a randomized, perioperative phase 1 trial.

Abstract

Vorasidenib and ivosidenib inhibit mutant forms of isocitrate dehydrogenase (mIDH) and have shown preliminary clinical activity against mIDH glioma. We evaluated both agents in a perioperative phase 1 trial to explore the mechanism of action in recurrent low-grade glioma (IGG) and select a molecule for phase 3 testing. Primary end-point was concentration of D-2-hydroxyglutarate (2-HG), the metabolic product of mIDH enzymes, measured in tumor tissue from 49 patients with mIDH1-R132H nonenhancing gliomas following randomized treatment with vorasidenib (50 mg or 10 mg once daily, q.d.), ivosidenib (500 mg q.d. or 250 mg twice daily) or no treatment before surgery. Tumor 2-HG concentrations were reduced by 92.6% (95% credible interval (CrI), 76.1-97.6) and 91.1% (95% CrI, 72.0-97.0) in patients treated with vorasidenib 50 mg q.d. and ivosidenib 500 mg q.d., respectively. Both agents were well tolerated and follow-up is ongoing. In exploratory analyses, 2-HG reduction was associated with increased DNA 5-hydroxymethylcytosine, reversal of 'proneural' and 'stemness' gene expression signatures, decreased tumor cell proliferation and immune cell activation. Vorasidenib, which showed brain penetrance and more consistent 2-HG suppression than ivosidenib, was advanced to phase 3 testing in patients with mIDH LGGs. Funded by Agios Pharmaceuticals, Inc. and Servier Pharmaceuticals LLC; ClinicalTrials.gov number NCT03343197.

• Authors: Ingo K Mellinghoff, Min Lu, Patrick Y Wen, Jennie W Taylor, Elizabeth A Maher, Isabel Arrillaga-Romany, Katherine B Peters, Benjamin M Ellingson, Marc K Rosenblum, Saewon Chun, Kha Le, Ania Tassinari, Sung Choe, Youssef Toubouti, Steven Schoenfeld, Shuchi S Pandya, Islam Hassan, Lori Steelman, Jennifer L Clarke, Timothy F Cloughesy
• Journal: Nature medicine (Nat Med) Vol. 29 Issue 3 Pg. 615-622 (03 2023) ISSN: 1546-170X [Electronic] United States
• PMID: 36823302 (Publication Type: Clinical Trial, Phase I, Journal Article, Research Support, Non-U.S. Gov't, Research Support, N.I.H., Extramural)
• Copyright: © 2023. The Author(s), under exclusive licence to Springer Nature America, Inc.

Chemical References

• vorasidenib
• ivosidenib
• Pyridines
• Isocitrate Dehydrogenase
• Pharmaceutical Preparations
• IDH1 protein, human

Topics

• Humans
• Pyridines (adverse effects)
• Isocitrate Dehydrogenase (genetics)
• Glioma (drug therapy, genetics)
• Mutation (genetics)
• Pharmaceutical Preparations
• Brain Neoplasms (drug therapy, genetics)