FDA Approval Summary: Vorasidenib for IDH-mutant Grade 2 Astrocytoma or Oligodendroglioma following surgery

On August 6, 2024, the U.S. Food and Drug Administration (FDA) granted traditional approval to vorasidenib (VORANIGO, Servier Pharmaceuticals, LLC) for the treatment of adult and pediatric patients 12 years and older with Grade 2 astrocytoma or oligodendroglioma with a susceptible isocitrate dehydrogenase-1 or 2 (IDH1 or IDH2) mutation following surgery including biopsy, sub-total resection, or gross total resection. The approval was based on data from a randomized, multicenter, double-blind trial of vorasidenib compared to placebo. The primary objective was to demonstrate the efficacy of vorasidenib based on radiographic progression-free survival (PFS) per blinded independent central review (BICR) according to the modified Response Assessment for Neuro-oncology for Low-Grade Gliomas (RANO-LGG) criteria. PFS was assessed in 331 patients, and the hazard ratio (HR) was 0.39 (95% CI: 0.27, 0.56; p-value <0.0001). The most common (≥15%) adverse reactions included fatigue, headache, COVID-19, musculoskeletal pain, diarrhea, nausea, and seizure. PFS was considered an appropriate endpoint for this disease considering the long natural history and the randomized design allowed for interpretation of the treatment effect in this rare malignancy. This was the first FDA approval of a targeted therapy for IDH-mutant, Grade 2 gliomas.