On June 16, 2021 Servier, a growing leader in oncology committed to bringing the promise of tomorrow to the patients we serve, reported that Clinical Cancer Research has published data from its Phase I study evaluating single-agent vorasidenib in isocitrate dehydrogenase (IDH) mutant advanced solid tumors, including low-grade glioma (Press release, Servier, JUN 16, 2021, View Source [SID1234584082]). Vorasidenib is an investigational, oral, selective, brain-penetrant dual inhibitor of mutant IDH1 and IDH2 enzymes.
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In the first-in-human study (NCT02481154), vorasidenib demonstrated both a favorable safety profile at doses <100 mg once daily and preliminary clinical activity in recurrent or progressive IDH1/2 mutant low-grade glioma. The study data demonstrated a median progression-free survival of 36.8 months (3.1 years) [95% confidence interval (CI), 11.2–40.8 months] for patients with nonenhancing low-grade glioma. The protocol-defined objective response rate per Response Assessment in Neuro-Oncology criteria for LGG (RANO-LGG) in patients with nonenhancing low-grade glioma was 18% (one partial response, three minor responses). Exploratory evaluation of tumor volumes showed sustained tumor shrinkage in multiple patients with nonenhancing low-grade glioma.
"Given the toxicities associated with chemotherapy and radiation, there remains a significant unmet need to improve treatment options for patients living with IDH mutant low-grade glioma," said Tim Cloughesy, M.D., David Geffen School of Medicine, Department of Neurology, University of California, Los Angeles, an investigator for the Phase 1 study. "These early results reinforce the potential benefit of vorasidenib and the further exploration of more targeted therapies."
Mutations in the metabolic enzymes IDH1/2 occur in up to approximately 80% of patients with low-grade gliomas. Standard treatment of low-grade gliomas includes tumor resection, followed by radiation and chemotherapy as appropriate. This treatment is not curative and current therapy is associated with short- and long-term toxicity, with most patients experiencing disease recurrence and progression to a higher tumor grade. In this study, vorasidenib demonstrated a favorable safety profile. Dose-limiting toxicities of elevated transaminases occurred at doses ≥100 mg and were reversible.
"We are excited to announce the publication of our first clinical data manuscript in glioma in Clinical Cancer Research, underscoring the potential benefit of vorasidenib in IDH mutant low-grade glioma," said Susan Pandya, M.D., Vice President, Clinical Development, Head of Cancer Metabolism Global Development, Servier Pharmaceuticals. "These data provide further support for our registration-enabling Phase 3 INDIGO study evaluating the activity of vorasidenib at an early stage of the disease where delaying the need for more aggressive treatments could provide a meaningful benefit to patients."
Vorasidenib is currently being evaluated in the registration-enabling Phase 3 INDIGO study as a potential treatment for patients with residual or recurrent grade 2 low-grade glioma (NCT04164901).
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Vorasidenib Phase 1 Dose-Escalation Study
Vorasidenib, an investigational, oral, selective, brain-penetrant dual inhibitor of mutant IDH1 and IDH2 enzymes, is being evaluated as a single agent in an ongoing Phase 1 dose-escalation trial in IDH1/2 mutant advanced solid tumors (n=93), including glioma (n=52). Vorasidenib was administered orally, once daily, in 28-day cycles until progression or unacceptable toxicity. Enrollment was completed in June 2017 (NCT02481154).
Vorasidenib INDIGO Phase 3 Study
Vorasidenib, an investigational, oral, selective, brain-penetrant dual inhibitor of mutant IDH1 and IDH2 enzymes, is currently being evaluated in the registration-enabling Phase 3 INDIGO study as a potential treatment for patients with residual or recurrent grade 2 low-grade glioma (NCT04164901).
About Glioma
Glioma presents in varying degrees of tumor aggressiveness, ranging from slower growing (low-grade glioma) to rapidly progressing (high-grade glioma-Glioblastoma Multiforme). Tumor enhancement is an imaging characteristic assessed by magnetic resonance imaging (MRI), and enhancing tumors are more likely to be high-grade.
Common symptoms of glioma include seizures, memory disturbance, sensory impairment and neurologic deficits. The long-term prognosis is poor, and regardless of treatment, the majority of patients with low-grade gliomas will have recurrent disease that will progress over time. Approximately 11,000 low-grade glioma patients are diagnosed annually in the U.S. and EU and approximately 80% have an IDH mutation.