The U.S. Food and Drug Administration (FDA) has approved olutasidenib for adult patients with relapsed or refractory acute myeloid leukemia (AML) who have a susceptible isocitrate dehydrogenase-1 (IDH1) mutation. This approval marks a significant advancement in the treatment of this aggressive blood cancer, offering a new targeted therapy option for patients who have failed prior treatments.
The FDA's decision was based on data from the single-arm Study 2102-HEM-101 (NCT02719574), a clinical trial evaluating the efficacy and safety of olutasidenib in patients with relapsed or refractory AML and an IDH1 mutation. The study demonstrated a complete remission (CR) plus CR with partial hematologic recovery (CRh) rate of 35% (95% CI, 27%-43%) among patients receiving olutasidenib. Specifically, the CR rate was 32%, and the CRh rate was 2.7%.
The median time to CR plus CRh was 1.9 months (range, 0.9-5.6), and the median duration of CR+CRh among patients was 25.9 months (95% CI, 13.5-not reached). These results indicate a rapid onset of response and a durable remission in a subset of patients.
Transfusion Independence
An important secondary endpoint of the study was transfusion independence. Among 86 patients who required red blood cell or platelet transfusions at baseline, 34% (n = 29) became independent of these transfusions for at least 56 days after baseline. Furthermore, of the 61 patients who were independent of both red blood cell and platelet transfusions at baseline, 64% (39) remained transfusion independent after 56 days following baseline. This suggests that olutasidenib can reduce the need for supportive care in a substantial proportion of patients.
Dosage and Administration
In the clinical trial, patients received 150 mg of oral olutasidenib twice daily until disease progression, unacceptable toxicity, or hematopoietic stem cell transplantation. The median treatment duration was 4.7 months (range, 0.1-26), and 11% of patients underwent hematopoietic stem cell transplantation following receipt of the study drug.
Adverse Events
The most common adverse effects observed in at least 20% of patients during the study included nausea, fatigue or malaise, arthralgia, constipation, leukocytosis, dyspnea, fever, rash, mucositis, diarrhea, and transaminitis. Healthcare professionals should monitor patients for these adverse events and manage them appropriately.
The FDA also approved the Abbott RealTime IDH1 Assay, a companion diagnostic test used to identify patients with AML who have a susceptible IDH1 mutation and are therefore eligible for olutasidenib treatment. This ensures that the therapy is targeted to the appropriate patient population, maximizing its potential benefit.
