The U.S. Food and Drug Administration (FDA) has granted approval to Voranigo (vorasidenib), an isocitrate dehydrogenase-1 (IDH1) and isocitrate dehydrogenase-2 (IDH2) inhibitor, for the treatment of adult and pediatric patients aged 12 years and older with Grade 2 astrocytoma or oligodendroglioma harboring a susceptible IDH1 or IDH2 mutation, following surgical intervention such as biopsy, sub-total resection, or gross total resection. Developed by Servier, Voranigo represents a significant advancement in the management of these brain tumors, offering a once-daily oral treatment option.
Diffuse gliomas with IDH mutations are the most common malignant primary brain tumors diagnosed in adults younger than 50 years of age. These tumors are typically incurable with current therapies, and without treatment, they continue to grow and infiltrate normal brain tissue. The approval of vorasidenib addresses a critical unmet need in this patient population, providing a targeted therapy that can significantly extend progression-free survival.
Clinical Efficacy and Safety
The approval of Voranigo is supported by data from the pivotal Phase 3 INDIGO clinical trial, which was published in The New England Journal of Medicine. The study demonstrated a statistically significant and clinically meaningful improvement in progression-free survival (PFS) with vorasidenib compared to placebo. Specifically, median PFS was 27.7 months in the vorasidenib group compared to 11.1 months in the placebo group (Hazard Ratio [HR], 0.39; 95% Confidence Interval [CI], 0.27 to 0.56; 1-sided P<0.001).
The INDIGO trial also met its key secondary endpoint of time to next intervention (TTNI), with vorasidenib demonstrating a statistically significant benefit (HR, 0.26; 95% CI, 0.15 to 0.43; 1-sided P<0.001). Median TTNI was not reached for vorasidenib and was 17.8 months for placebo. Furthermore, vorasidenib was shown to reduce tumor volume by a mean of 2.5% every 6 months, while tumor volume increased by a mean of 13.9% every 6 months for patients randomized to the placebo arm.
The safety profile of vorasidenib was consistent with results from Phase 1 studies. The most common (≥15%) adverse reactions were fatigue, COVID-19, musculoskeletal pain, diarrhea, and seizure.
Mechanism of Action
Vorasidenib functions by inhibiting mutant IDH1 and IDH2 enzymes, which are implicated in the pathogenesis of IDH-mutant gliomas. Mutations in IDH1 and IDH2 prevent cells from differentiating properly, leading to uncontrolled growth. By reducing the activity of these mutant enzymes, vorasidenib helps to control the disease.
Implications for Patients
The approval of Voranigo marks a significant advancement in the treatment landscape for Grade 2 IDH-mutant gliomas. Prior to this approval, treatment options were limited, and patients faced the prospect of an incurable disease with progressive growth. Vorasidenib offers a new, targeted approach that can significantly extend progression-free survival and delay the need for subsequent interventions.
According to Ralph DeVitto, President & CEO of the American Brain Tumor Association, "The FDA approval of Voranigo marks a monumental breakthrough in glioma treatment, offering renewed hope for patients and their families living with this relentless disease."
Servier is committed to researching the applicability of IDH-mutant inhibition in glioma and other cancers, with the goal of advancing more targeted therapies and helping the right patients find the right treatment at the right time.
