A New Drug Offers Hope for Younger Patients with Brain Tumors

A top UVA Health cancer expert is highlighting how a new drug could transform how doctors treat a brain tumor that typically strikes younger people.

David Schiff, MD, the co-director of UVA Cancer CenterÔÇÖs Neuro-Oncology Center, has authored an editorial in the prestigious New England Journal of Medicine describing the potential significance of the drug vorasidenib for patients with tumors known as ÔÇ£grade 2 IDH-mutant gliomas.ÔÇØ The drug, when tested in the INDIGO clinical trial, was found to slow tumor growth significantly and extended the average time until the tumor started growing from 11.1 months to more than 27 months.

If the drug receives approval from the federal Food and Drug Administration, it would become the first targeted therapy for low-grade gliomas. But Schiff notes that there are also other recent advances that are improving our understanding of such gliomas.

ÔÇ£It used to be that we thought of all gliomas as being on a spectrum,ÔÇØ Schiff said. ÔÇ£We now understand that those with the IDH gene mutation have a markedly different biology, outcome and, as this study shows, vulnerabilities that new therapies can exploit.ÔÇØ

About IDH-Mutant Gliomas

Approximately 2,500 Americans with a median age of only 40 are diagnosed with grade 2 IDH-mutant gliomas each year. The tumors often affect the patientsÔÇÖ ability to think and hold a job, as well as interfere with other aspects of daily life. Eventually, the tumors become resistant to treatment options and typically prove fatal.┬á

Because of the limited treatment options available, doctors usually take a ÔÇ£watch and waitÔÇØ approach to managing the brain tumors, holding off on treatment until after the tumor progresses. But vorasidenib could change that, Schiff notes. The drug could offer the first early treatment for the cancer, giving patients an important new option that could extend their lives.

In the INDIGO trial, more than 300 patients were randomized to receive vorasidenib or a harmless placebo. Neither the patients nor their doctors knew which the patients were receiving. Schiff, in his editorial, describes the results as ÔÇ£striking.ÔÇØ Not only did the patients receiving vorasidenib live longer, but they did not need more toxic treatments, such as radiation and chemotherapy, as quickly as the patients receiving placebos.

Schiff was so impressed by the success of the drug that he writes that vorasidenib could ÔÇ£put a nail in the coffinÔÇØ of the watch-and-wait approach for such brain tumors.┬á

ÔÇ£There are still many unanswered questions about how we can best utilize this new medication if and when it receives FDA approval,ÔÇØ Schiff said. ÔÇ£Nonetheless, considering that existing standard therapies for these tumors [radiation and chemotherapy] are tough on patients, with short- and long-term side effects, it will be wonderful to have a useful and very well-tolerated treatment option.ÔÇØ

Findings Published

Both the┬áresults of the INDIGO trial┬áand┬áSchiffÔÇÖs editorial┬áhave been published in the New England Journal of Medicine.

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