Monitoring and Managing Adverse Events With IDH Inhibitors

EP: 1.Redefining Gliomas Through Molecular Classification

EP: 2.Treatment Workflow for IDH-Mutant Gliomas

EP: 3.Integrating Molecular Markers Into Glioma Treatment Planning

EP: 4.Postsurgical Assessment and Early Management Considerations for IDH-Mutant Gliomas

EP: 5.Inside INDIGO: Updated Trial Insights and Clinical Implications

EP: 6.Beyond the Trial: Treatment Considerations and Sequencing for IDH-Mutant Gliomas

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EP: 7.Monitoring and Managing Adverse Events With IDH Inhibitors

EP: 8.Recent Research and Future Directions in IDH-Mutant Gliomas

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IDH inhibitors, particularly voracidinib, require careful monitoring for hepatotoxicity, though this adverse event occurs in only a small percentage of patients. The standard monitoring protocol includes baseline liver function tests (LFTs), followed by testing every 2 weeks for the first 2 months, then monthly for up to 2 years. However, most practitioners modify this schedule based on individual patient risk factors and clinical judgment, often extending intervals to every 2 to 3 months after the initial high-risk period.

When hepatotoxicity occurs, it typically manifests within the first 6 months of treatment and is generally manageable through dose holds and adjustments. Expert oncologists emphasize the importance of investigating other potential causes of elevated liver enzymes, including concurrent medications, supplements (particularly green tea extract), alcohol use, and acetaminophen intake. The panel shares clinical experience showing that many LFT elevations are reversible and don't require permanent treatment discontinuation, allowing patients to continue benefiting from IDH inhibitor therapy.

Beyond hepatotoxicity, IDH inhibitors can cause musculoskeletal symptoms including arthralgias and myalgias in a small subset of patients, though these are typically mild and manageable. Gastrointestinal adverse effects such as heartburn and indigestion are also reported but generally well tolerated. The experts stress the importance of comprehensive patient education about potential adverse effects, drug interactions, and the need for regular monitoring, while reassuring patients that serious adverse events are uncommon and most adverse effects are reversible with appropriate management.