Enasidenib and ivosidenib in AML

Minerva Med. 2020 Oct;111(5):411-426. doi: 10.23736/S0026-4806.20.07024-X. Epub 2020 Sep 21.

Abstract

The isocitrate dehydrogenases enzymes, IDH1 and IDH2, catalyze the conversion of isocitrate to α-ketoglutarate (αKG) in the cell cytoplasm and mitochondria, respectively, and contribute to generating the dihydronicotinamide-adenine dinucleotide phosphate (NADPH) as reductive potential in different cellular processes. Mutations in IDH1 and IDH2 genes are found collectively in about 20-25% of acute myeloid leukemia (AML) patients. Mutant IDH enzymes have neomorphic activity and convert αKG to the oncometabolite R-2-hydroxyglutarate (R-2-HG) which accumulates at high levels in the cell and hampers the function of αKG-dependent enzymes, including epigenetic regulators, thus leading to altered gene expression and block of differentiation and contributing to leukemia development. Inhibition of the neomorphic mutants induces marked decrease in R-2-HG levels and restores myeloid differentiation. Enasidenib and ivosidenib are potent and selective inhibitors of mutant IDH2 and IDH1, respectively, act as differentiating agents and showed clinical activity in relapsed/refractory (R/R) AML harboring the specific mutation. As single agents, both drugs have been approved by the Food and Drug Administration (FDA) for the treatment of R/R AML. The relevance of IDH targeting within either single agent approach or, most importantly, combinatorial treatments in AML will be discussed.

Publication types

  • Review

MeSH terms

  • Aminopyridines / adverse effects
  • Aminopyridines / therapeutic use*
  • Antineoplastic Agents / adverse effects
  • Antineoplastic Agents / therapeutic use*
  • Cell Differentiation / drug effects
  • Clinical Trials as Topic
  • Glutarates / metabolism
  • Glycine / adverse effects
  • Glycine / analogs & derivatives*
  • Glycine / therapeutic use
  • Humans
  • Isocitrate Dehydrogenase / antagonists & inhibitors*
  • Isocitrate Dehydrogenase / genetics
  • Isocitrate Dehydrogenase / metabolism
  • Isocitrates / metabolism
  • Ketoglutaric Acids / metabolism
  • Leukemia, Myeloid, Acute / drug therapy*
  • Leukemia, Myeloid, Acute / genetics
  • Leukemia, Myeloid, Acute / metabolism
  • Leukemia, Myeloid, Acute / pathology
  • Multicenter Studies as Topic
  • Mutation, Missense
  • NADP / biosynthesis
  • Pyridines / adverse effects
  • Pyridines / therapeutic use*
  • Syndrome
  • Triazines / adverse effects
  • Triazines / therapeutic use*

Substances

  • Aminopyridines
  • Antineoplastic Agents
  • Glutarates
  • Isocitrates
  • Ketoglutaric Acids
  • Pyridines
  • Triazines
  • enasidenib
  • NADP
  • isocitric acid
  • IDH2 protein, human
  • Isocitrate Dehydrogenase
  • IDH1 protein, human
  • ivosidenib
  • Glycine