Vorasidenib, a dual isocitrate dehydrogenase 1/2 (IDH1/2) inhibitor, showed superior efficacy in prolonging progression-free survival and time to next intervention in IDH-mutant grade 2 gliomas. This case is part of an ongoing institutional study exploring the impact of vorasidenib on seizure control and the potential of [18F]fluorodopa (F-DOPA) positron emission tomography (PET) to detect treatment response earlier than magnetic resonance imaging (MRI). A 52-year-old patient with grade 2 IDH-mutant 1p19q-codeleted oligodendroglioma and persistent postoperative seizures received vorasidenib. He achieved early seizure freedom from the first month of therapy without any change of antiseizure medication (ASM). At 3 and 6 months after treatment, MRI showed stable disease (with a slight progressive reduction in tumor volume), whereas F-DOPA PET revealed a significant decrease in tracer uptake starting from the third month, which was confirmed at 6 months, corresponding to a partial response according to PET Response Assessment in Neuro-Oncology 1.0 criteria. This is the first report of an IDH-mutant grade 2 glioma patient achieving early seizure control and metabolic response on F-DOPA PET after vorasidenib. It highlights the potential of vorasidenib for seizure management and the value of F-DOPA PET for early treatment assessment. Further studies are required to evaluate long-term seizure control and potential reduction of ASM in IDH-mutant low-grade gliomas treated with vorasidenib.
Early seizure freedom with [18F]fluorodopa positron emission tomography response after isocitrate dehydrogenase inhibition with vorasidenib: First case report
Bruno, Francesco;Pellerino, Alessia;Pronello, Edoardo;Zotta, Michela;Morbelli, Silvia
2025-01-01
Abstract
Vorasidenib, a dual isocitrate dehydrogenase 1/2 (IDH1/2) inhibitor, showed superior efficacy in prolonging progression-free survival and time to next intervention in IDH-mutant grade 2 gliomas. This case is part of an ongoing institutional study exploring the impact of vorasidenib on seizure control and the potential of [18F]fluorodopa (F-DOPA) positron emission tomography (PET) to detect treatment response earlier than magnetic resonance imaging (MRI). A 52-year-old patient with grade 2 IDH-mutant 1p19q-codeleted oligodendroglioma and persistent postoperative seizures received vorasidenib. He achieved early seizure freedom from the first month of therapy without any change of antiseizure medication (ASM). At 3 and 6 months after treatment, MRI showed stable disease (with a slight progressive reduction in tumor volume), whereas F-DOPA PET revealed a significant decrease in tracer uptake starting from the third month, which was confirmed at 6 months, corresponding to a partial response according to PET Response Assessment in Neuro-Oncology 1.0 criteria. This is the first report of an IDH-mutant grade 2 glioma patient achieving early seizure control and metabolic response on F-DOPA PET after vorasidenib. It highlights the potential of vorasidenib for seizure management and the value of F-DOPA PET for early treatment assessment. Further studies are required to evaluate long-term seizure control and potential reduction of ASM in IDH-mutant low-grade gliomas treated with vorasidenib.
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