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Durable Remissions with Ivosidenib in IDH1 -Mutated Relapsed or Refractory AML

Open access
DiNardo, Courtney D., Stein, Eytan M., de Botton, Stéphane, Roboz, Gail J., Altman, Jessica K., Mims, Alice S., Swords, Ronan, Collins, Robert H., Mannis, Gabriel N., Pollyea, Daniel A., Donnellan, Will, Fathi, Amir T., Pigneux, Arnaud, Erba, Harry P., Prince, Gabrielle T., Stein, Anthony S., Uy, Geoffrey L., Foran, James M., Traer, Elie, Stuart, Robert K., Arellano, Martha L., Slack, James L., Sekeres, Mikkael A., Willekens, Christophe, Choe, Sung, Wang, Hongfang, Zhang, Vickie, Yen, Katharine E., Kapsalis, Stephanie M., Yang, Hua, Dai, David, Fan, Bin, Goldwasser, Meredith, Liu, Hua, Agresta, Sam, Wu, Bin, Attar, Eyal C., Tallman, Martin S., Stone, Richard M., Kantarjian, Hagop M.·2018·New England Journal of Medicine

Abstract

BACKGROUND: Mutations in the gene encoding isocitrate dehydrogenase 1 ( IDH1) occur in 6 to 10% of patients with acute myeloid leukemia (AML). Ivosidenib (AG-120) is an oral, targeted, small-molecule inhibitor of mutant IDH1. METHODS: We conducted a phase 1 dose-escalation and dose-expansion study of ivosidenib monotherapy in IDH1-mutated AML. Safety and efficacy were assessed in all treated patients. The primary efficacy population included patients with relapsed or refractory AML receiving 500 mg of ivosidenib daily with at least 6 months of follow-up. RESULTS: Overall, 258 patients received ivosidenib and had safety outcomes assessed. Among patients with relapsed or refractory AML (179 patients), treatment-related adverse events of grade 3 or higher that occurred in at least 3 patients were prolongation of the QT interval (in 7.8% of the patients), the IDH differentiation syndrome (in 3.9%), anemia (in 2.2%), thrombocytopenia or a decrease in the platelet count (in 3.4%), and leukocytosis (in 1.7%). In the primary efficacy population (125 patients), the rate of complete remission or complete remission with partial hematologic recovery was 30.4% (95% confidence interval [CI], 22.5 to 39.3), the rate of complete remission was 21.6% (95% CI, 14.7 to 29.8), and the overall response rate was 41.6% (95% CI, 32.9 to 50.8). The median durations of these responses were 8.2 months (95% CI, 5.5 to 12.0), 9.3 months (95% CI, 5.6 to 18.3), and 6.5 months (95% CI, 4.6 to 9.3), respectively. Transfusion independence was attained in 29 of 84 patients (35%), and patients who had a response had fewer infections and febrile neutropenia episodes than those who did not have a response. Among 34 patients who had a complete remission or complete remission with partial hematologic recovery, 7 (21%) had no residual detectable IDH1 mutations on digital polymerase-chain-reaction assay. No preexisting co-occurring single gene mutation predicted clinical response or resistance to treatment. CONCLUSIONS: In patients with advanced IDH1-mutated relapsed or refractory AML, ivosidenib at a dose of 500 mg daily was associated with a low frequency of grade 3 or higher treatment-related adverse events and with transfusion independence, durable remissions, and molecular remissions in some patients with complete remission. (Funded by Agios Pharmaceuticals; ClinicalTrials.gov number, NCT02074839 .).

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Authors
DiNardo, C. D., Stein, E. M., de Botton, S., Roboz, G. J., Altman, J. K., Mims, A. S., Swords, R., Collins, R. H., Mannis, G. N., Pollyea, D. A., Donnellan, W., Fathi, A. T., Pigneux, A., Erba, H. P., Prince, G. T., Stein, A. S., Uy, G. L., Foran, J. M., Traer, E., Stuart, R. K., Arellano, M. L., Slack, J. L., Sekeres, M. A., Willekens, C., Choe, S., Wang, H., Zhang, V., Yen, K. E., Kapsalis, S. M., Yang, H., Dai, D., Fan, B., Goldwasser, M., Liu, H., Agresta, S., Wu, B., Attar, E. C., Tallman, M. S., Stone, R. M., & Kantarjian, H. M.
Venue
New England Journal of Medicine
Published
2018-06-21
Volume
378
Issue
25
Pages
2386-2398
ISSN
  • 0028-4793 (ISSN-L)
  • 1533-4406
OpenAlex
W2806682325
Cited by
1,454
References
21
FWCI
108.36
Type
journal article
Language
en
Open access
bronze

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CoChat. (2026). Citation check: Durable Remissions with Ivosidenib in IDH1 -Mutated Relapsed or Refractory AML. https://app.cochat.ai/papers/10.1056/nejmoa1716984
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DiNardo, C. D., Stein, E. M., de Botton, S., Roboz, G. J., Altman, J. K., Mims, A. S., Swords, R., Collins, R. H., Mannis, G. N., Pollyea, D. A., Donnellan, W., Fathi, A. T., Pigneux, A., Erba, H. P., Prince, G. T., Stein, A. S., Uy, G. L., Foran, J. M., Traer, E., . . . Kantarjian, H. M. (2018). Durable Remissions with Ivosidenib in IDH1 -Mutated Relapsed or Refractory AML. New England Journal of Medicine. https://doi.org/10.1056/nejmoa1716984

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Bibliographic data: Semantic Scholar, OpenAlex, Crossref.

Contains information from the Semantic Scholar Academic Graph Datasets, made available under the ODC Attribution License (ODC-BY 1.0).

Semantic Scholar’s data is described in: Kinney, R., et al. (2023). The Semantic Scholar Open Data Platform. arXiv:2301.10140.