2023-04-26 06:52:14
First step forward in 20 years: important progress because progression-free survival is lengthened and radio and chemotherapy can be postponed
For the first time after 20 years of experimentation, one arrives new cure against gliomas, brain tumors often affecting young people, with an important impact on the quality of life and work capacity. Whenever possible they are surgically removed, but in most cases the operation is not resolving and we proceed with radiotherapy and chemotherapy. Many patients live several years with this strategy, but researchers have long been committed to finding more effective and less invasive therapeutic strategies.
I study
The results of the INDIGO study (a phase three trial, the last before the official approval of a new drug) indicate that with vorasidenib, which targets the mutation affecting the IDH1 and IDH2 genes, important progress is being made because it lengthens progression-free survival. What does it mean exactly? We are talking about the first study capable of demonstrating a benefit from a drug with a targeted action in patients with operated low-grade gliomas who present a specific alteration (the mutation of the IDH1 or IDH2 genes, fundamental in the birth and development of gliomas of low grade) – replies Enrico Franceschi, director of Oncology of the nervous system at the IRCCS Institute of Neurological Sciences of Bologna -. Until now, post-surgical treatment consisted of radiotherapy and chemotherapy, but today, thanks to this new drug, these treatments can be significantly postponed. Other important information: “convenient” vorasidenib, taken in tablets and very well tolerated (the main side effect is the rise in transaminases).
Low-grade gliomas: oligodendrogliomas and astrocytomas
Gliomas affect about 5 out of 100,000 people a year and account for about 40% of tumors affecting the brain. There are different types, some are aggressive and have a very severe prognosis (such as glioblastoma), others less so. Low-grade gliomas are rare brain neoplasms, they affect 2-3 people out of 100,000 a year, generally young people, around 30-40 years of age – explains Franceschi -. They often present with epileptic seizures: it is important to recognize these pathologies promptly in order to set up the therapeutic program as soon as possible. Currently the median survival exceeds 10 years, with variations that largely depend on the genetic characteristics of the tumor: however, these are neoplasms which, if when the scalpel is not resolving, grow continuously, more or less slowly, and evolve towards types with greater malignity.
The therapies
According to international guidelines, the surgery considered the initial treatment and aims at the removal of all the neoplastic mass visible on MRI. Radical surgical treatment is associated with an increase in disease-free progression (ie, the time that passes before the cancer comes back) and survival. Unfortunately for a radical elimination not always feasible or, even if this goal has been achieved, it may happen that the tumor starts growing again and often evolves towards greater levels of aggression. Precisely for this reason, after the operation, if there are elements of risk, radiotherapy and chemotherapy are performed immediately to lengthen the time for regrowth and also overall survival – concludes Franceschi -. The data from the INDIGO study, which will be presented at the American Asco world congress in June 2023, indicate that the new drug (still awaiting official approval both in the USA and in Europe) is capable of lengthening the time for disease regrowth and significant post-surgical treatments.
April 26, 2023 (change April 26, 2023 | 06:51)
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