Vorasidenib in IDH-mutant glioma: Belgian experts discuss clinical practice and future directions

In this in-depth video, Prof Dr Bart Neyns and Dr Pierre Frères discuss the updated results from the pivotal INDIGO trial evaluating vorasidenib in patients with grade 2 IDH-mutant glioma after surgery.^1,2 The conversation focuses on how the longer follow-up data may translate into clinical practice and patient counselling.

With more than three years of median follow-up, vorasidenib continued to delay disease progression and postponed the need for radiotherapy or chemotherapy. This is particularly relevant in a young and active patient population, for whom delaying treatments associated with potential long-term toxicity is an important clinical goal. The experts also highlight the impact of vorasidenib on seizure control, with updated data suggesting a reduction in both seizure frequency and severity. Another important point is the gradual nature of radiographic response. Response rates increased over time, reaching approximately 20% with longer treatment, and the median time to partial response was around one year. This underlines the need to counsel patients that visible tumour shrinkage may take time and that stable disease can still reflect meaningful treatment activity. From a practical perspective, vorasidenib appears generally well tolerated, although liver function monitoring is important, particularly early during treatment. 

The experts also discuss the Belgian context, including anticipated reimbursement and the role of ongoing studies such as the VIGOR trial, which is evaluating vorasidenib as maintenance treatment following completion of first-line chemoradiotherapy in patients with IDH-mutant glioma WHO CNS Grade 2 or 3 astrocytoma.