Vorasidenib

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Vorasidenib
Vorasidenib v2.svg
Clinical data
Trade names Voranigo
AHFS/Drugs.com Monograph
MedlinePlus a624055
License data
Pregnancy
category
Routes of
administration 		By mouth
ATC code
Legal status
Legal status
Identifiers
  • 6-(6-Chloropyridin-2-yl)-2-N,4-N-bis[(2R)-1,1,1-trifluoropropan-2-yl]-1,3,5-triazine-2,4-diamine
CAS Number
PubChem CID
IUPHAR/BPS
DrugBank
ChemSpider
UNII
KEGG
ChEMBL
Chemical and physical data
Formula C14H13ClF6N6
Molar mass 414.74 g·mol−1
3D model (JSmol)
  • C[C@H](C(F)(F)F)NC1=NC(=NC(=N1)C2=NC(=CC=C2)Cl)N[C@H](C)C(F)(F)F
  • InChI=1S/C14H13ClF6N6/c1-6(13(16,17)18)22-11-25-10(8-4-3-5-9(15)24-8)26-12(27-11)23-7(2)14(19,20)21/h3-7H,1-2H3,(H2,22,23,25,26,27)/t6-,7-/m1/s1
  • Key:QCZAWDGAVJMPTA-RNFRBKRXSA-N

Vorasidenib, sold under the brand name Voranigo, is an anti-cancer medication used for the treatment of certain forms of glioma. [5] [6] Vorasidenib is a dual mutant isocitrate dehydrogenase 1 (IDH1) and isocitrate dehydrogenase 2 (IDH2) inhibitor. [5] [6] In people with astrocytoma or oligodendroglioma, IDH1 and IDH2 mutations lead to overproduction of the oncogenic metabolite 2-hydroxyglutarate (2-HG), which results in impaired cellular differentiation contributing to oncogenesis. [7] By inhibiting the IDH1 and IDH2 mutated proteins, vorasidenib inhibits the abnormal production of 2-HG thereby leading to differentiation of malignant cells and a reduction in their proliferation. [7]

Contents

The most common adverse reactions include fatigue, headache, increased risk of COVID-19 infection, musculoskeletal pain, diarrhea, nausea, and seizures. [6]

Vorasidenib was approved for medical use in the United States in August 2024. [6] [8] [9] It is the first approval by the US Food and Drug Administration (FDA) of a systemic therapy for people with grade 2 astrocytoma or oligodendroglioma with a susceptible isocitrate dehydrogenase-1 or isocitrate dehydrogenase-2 mutation. [6]

Medical uses

Vorasidenib is indicated for the treatment of people aged twelve years of age and older with grade 2 astrocytoma or oligodendroglioma with a susceptible isocitrate dehydrogenase-1 or isocitrate dehydrogenase-2 mutation, following surgery including biopsy, sub-total resection, or gross total resection. [6]

Side effects

The most common adverse reactions include fatigue, headache, increased risk of COVID-19 infection, musculoskeletal pain, diarrhea, nausea, and seizures. [6] The most common grade 3 or 4 laboratory abnormalities include increased alanine aminotransferase, increased aspartate aminotransferase, GGT increased, and decreased neutrophils. [6]

Pharmacology

Agios Pharmaceuticals previously developed the mIDH1 inhibitor ivosidenib [10] and mIDH2 inhibitor enasidenib [11] [12] for treatment of acute myeloid leukemia (AML) with susceptible IDH1 or IDH2 mutations, respectively. However, ivosidenib and enasidenib have low brain exposure, precluding their use in gliomas. [13] Moreover, isoform switching between IDH1 and IDH2 has been observed as a mechanism of resistance to mIDH inhibitor therapy. [14] Vorasidenib was thus developed to improve blood-brain barrier penetration and inhibit both mIDH1/2. [13]

History

Efficacy was evaluated in 331 participants with grade 2 astrocytoma or oligodendroglioma with a susceptible isocitrate dehydrogenase-1 or isocitrate dehydrogenase-2 mutation following surgery enrolled in INDIGO (NCT04164901), a randomized, multicenter, double-blind, placebo-controlled trial. [6] Participants were randomized 1:1 to receive vorasidenib 40 mg orally once daily or placebo orally once daily until disease progression or unacceptable toxicity. [6] Isocitrate dehydrogenase-1 or isocitrate dehydrogenase-2 mutation status was prospectively determined by the Life Technologies Corporation Oncomine Dx Target Test. [6] Participants randomized to placebo were allowed to cross over to vorasidenib after documented radiographic disease progression. [6] Participants who received prior anti-cancer treatment, including chemotherapy or radiation therapy, were excluded. [6]

Society and culture

Vorasidenib was approved for medical use in the United States in August 2024. [6] [15] The FDA granted the application for vorasidenib priority review, fast track, breakthrough therapy, and orphan drug designations. [6]

In July 2025, the Committee for Medicinal Products for Human Use of the European Medicines Agency adopted a positive opinion, recommending the granting of a marketing authorization for the medicinal product Voranigo, intended for the treatment of low grade astrocytoma or oligodendroglioma with an isocitrate dehydrogenase‑1 (IDH1) R132 or isocitrate dehydrogenase-2 (IDH2) R172 mutation in people aged twelve years of age and older weighing at least 40 kilograms (88 lb). [7] The applicant for this medicinal product is Les Laboratoires Servier. [7]

References

  1. 1 2 "Voranigo (vorasidenib)". Therapeutic Goods Administration (TGA). 26 September 2024. Retrieved 12 October 2024.
  2. ↑ "Voranigo (Servier Laboratories (Aust) Pty Ltd)". Therapeutic Goods Administration (TGA). 9 December 2024. Retrieved 19 December 2024.
  3. ↑ "Summary Basis of Decision for Voranigo". Drug and Health Products Portal. 5 December 2024. Retrieved 25 January 2025.
  4. ↑ "Voranigo product information". Health Canada . 21 October 2024. Retrieved 27 December 2024.
  5. 1 2 3 "Voranigo- vorasidenib citrate tablet, film coated". DailyMed. 9 August 2024. Retrieved 15 August 2024.
  6. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 "FDA approves vorasidenib for Grade 2 astrocytoma or oligodendroglioma with a susceptible IDH1 or IDH2 mutation". U.S. Food and Drug Administration (FDA). 6 August 2024. Archived from the original on 7 August 2024. Retrieved 7 August 2024.PD-icon.svg This article incorporates text from this source, which is in the public domain .
  7. 1 2 3 4 "Voranigo EPAR". European Medicines Agency (EMA). 25 July 2025. Retrieved 27 July 2025. Text was copied from this source which is copyright European Medicines Agency. Reproduction is authorized provided the source is acknowledged.
  8. ↑ New Drug Therapy Approvals 2024 (PDF). U.S. Food and Drug Administration (FDA) (Report). January 2025. Archived from the original on 21 January 2025. Retrieved 21 January 2025.
  9. ↑ "Servier's Voranigo (vorasidenib) Tablets Receives FDA Approval as First Targeted Therapy for Grade 2 IDH-mutant Glioma" (Press release). Servier Pharmaceuticals. 6 August 2024. Archived from the original on 7 August 2024. Retrieved 7 August 2024– via PR Newswire.
  10. ↑ Popovici-Muller J, Lemieux RM, Artin E, Saunders JO, Salituro FG, Travins J, et al. (April 2018). "Discovery of AG-120 (Ivosidenib): A First-in-Class Mutant IDH1 Inhibitor for the Treatment of IDH1 Mutant Cancers". ACS Medicinal Chemistry Letters. 9 (4): 300–305. doi:10.1021/acsmedchemlett.7b00421. PMC   5900343 . PMID   29670690.
  11. ↑ Shih AH, Shank KR, Meydan C, Intlekofer AM, Ward P, Thompson CB, et al. (December 2014). "AG-221, a Small Molecule Mutant IDH2 Inhibitor, Remodels the Epigenetic State of IDH2-Mutant Cells and Induces Alterations in Self-Renewal/Differentiation in IDH2-Mutant AML Model in Vivo" . Blood. 124 (21): 437. doi:10.1182/blood.V124.21.437.437. ISSN   0006-4971.
  12. ↑ Yen K, Travins J, Wang F, David MD, Artin E, Straley K, et al. (May 2017). "AG-221, a First-in-Class Therapy Targeting Acute Myeloid Leukemia Harboring Oncogenic IDH2 Mutations". Cancer Discovery. 7 (5): 478–493. doi:10.1158/2159-8290.CD-16-1034. PMID   28193778.
  13. 1 2 Konteatis Z, Artin E, Nicolay B, Straley K, Padyana AK, Jin L, et al. (February 2020). "Vorasidenib (AG-881): A First-in-Class, Brain-Penetrant Dual Inhibitor of Mutant IDH1 and 2 for Treatment of Glioma". ACS Medicinal Chemistry Letters. 11 (2): 101–107. doi:10.1021/acsmedchemlett.9b00509. PMC   7025383 . PMID   32071674.
  14. ↑ Harding JJ, Lowery MA, Shih AH, Schvartzman JM, Hou S, Famulare C, et al. (December 2018). "Isoform Switching as a Mechanism of Acquired Resistance to Mutant Isocitrate Dehydrogenase Inhibition". Cancer Discovery. 8 (12): 1540–1547. doi:10.1158/2159-8290.CD-18-0877. PMC   6699636 . PMID   30355724.
  15. ↑ "Novel Drug Approvals for 2024". U.S. Food and Drug Administration (FDA). 1 October 2024. Retrieved 29 November 2024.

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