2018年7月20日 ，癌症生物制药公司Agios Pharmaceuticals宣布，其抗癌药物ivosidenib（商品名 Tibsovo）获得美国FDA的批准，用于经一款检测方法（雅培RealTime IDH1伴随诊断试剂盒）证实存在易感异柠檬酸脱氢酶-1（IDH1）突变的复发性或难治性急性髓系白血病（R/R AML）成人患者，Tibsovo是一种针对IDH1酶的口服靶向抑制剂，此次批准，使Tibsovo成为首个也是唯一一个获得FDA批准治疗IDH1突变R/R AML的药物。 

AML的特征是疾病进展迅速，是成人中最常见的急性白血病，每年在美国估计约有20,000例新发病例，大多数AML患者最终会复发。R/R AML的预后较差，五年生存率约为27％。对于6-10％的AML患者，IDH1酶突变会阻断正常的血液干细胞分化，从而导致急性白血病的发生。 

此次FDA批准TIBSOVO?用于具有IDH1突变的R/R AML患者是基于一项开放标签、单臂、多中心、剂量递增和扩增试验AG120-C-001的临床数据。这项研究包含了174名患者，他们以每日500毫克TIBSOVO?的起始剂量口服给药，直至疾病进展、发生不可接受的毒性或需要进行造血干细胞移植。研究的主要终点是联合的完全缓解（CR）和有部分血液学改善的完全缓解（CRh）率。CRh定义为骨髓中<5％的胚细胞没有疾病迹象且外周血计数部分恢复（血小板> 50,000 /微升和ANC> 500 /微升）。 

最终的临床结果显示：Tibsovo的CR+CRh率为32.8%（n=57/174，95%CI:25.8-40.3），其中CR率为24.7%（n=43/174，95%CI:18.5-31.8），CRh率为8%（n=14/174，95%CI:4.5-13.1）；CR+CRh中位持续时间8.2个月（95%CI:范围5.6-12个月），达到CR或CRh的患者中，从治疗到获得CR或CRh最佳缓解中位时间2.0个月（范围：0.9-5.6个月）；基线时依赖红细胞（RBC）和/或血小板输注的110例患者中，有41例（37.3%）在基线后56天不依赖RBC和血小板输注；基线时同时不依赖RBC和血小板输注的64例患者中，有38例（59.4%）在基线后56天仍然保持不依赖输注；174例患者中有21例（12%）在接受Tibsovo治疗后接受了干细胞移植。 

美国德克萨斯大学MD安德森癌症中心白血病系主席Hagop M. Kantarjian教授表示：R/R AML患者的治疗选择很少。临床研究表明Tibsovo能够提供强有力的持久缓解，并可以帮助患者实现和保持不依赖输注。对携带IDH突变的AML患者而言，IDH抑制剂代表了一类新的非细胞毒靶向疗法。

ivosidenib（商品名 Tibsovo）推剂量为：每天口服500毫克，含或不含食物，直至疾病进展或不可接受的毒性。

TIBSOVO® (ivosidenib) is indicated for the treatment of adult patients with relapsed or refractory acute myeloid leukemia (AML) with a susceptible isocitrate dehydrogenase-1 (IDH1) mutation as detected by an FDA-approved test. 

IMPORTANT SAFETY INFORMATION

WARNING: 

DIFFERENTIATION SYNDROME

Patients treated with TIBSOVO have experienced symptoms of differentiation syndrome, which can be fatal if not treated. Symptoms may include fever, dyspnea, hypoxia, pulmonary infiltrates, pleural or pericardial effusions, rapid weight gain or peripheral edema, hypotension, and hepatic, renal, or multi‑organ dysfunction. If differentiation syndrome is suspected, initiate corticosteroid therapy and hemodynamic monitoring until symptom resolution. 

WARNINGS AND PRECAUTIONS

Differentiation Syndrome: See Boxed WARNING. In the clinical trial, 19% (34/179) of patients with relapsed or refractory AML treated with TIBSOVO experienced differentiation syndrome. Differentiation syndrome is associated with rapid proliferation and differentiation of myeloid cells and may be life-threatening or fatal if not treated. Symptoms of differentiation syndrome in patients treated with TIBSOVO included noninfectious leukocytosis, peripheral edema, pyrexia, dyspnea, pleural effusion, hypotension, hypoxia, pulmonary edema, pneumonitis, pericardial effusion, rash, fluid overload, tumor lysis syndrome, and creatinine increased. Of the 34 patients who experienced differentiation syndrome, 27 (79%) recovered after treatment or after dose interruption of TIBSOVO. Differentiation syndrome occurred as early as 1 day and up to 3 months after TIBSOVO initiation and has been observed with or without concomitant leukocytosis. 

If differentiation syndrome is suspected, initiate dexamethasone 10 mg IV every 12 hours (or an equivalent dose of an alternative oral or IV corticosteroid) and hemodynamic monitoring until improvement. If concomitant noninfectious leukocytosis is observed, initiate treatment with hydroxyurea or leukapheresis, as clinically indicated. Taper corticosteroids and hydroxyurea after resolution of symptoms and administer corticosteroids for a minimum of 3 days. Symptoms of differentiation syndrome may recur with premature discontinuation of corticosteroid and/or hydroxyurea treatment. If severe signs and/or symptoms persist for more than 48 hours after initiation of corticosteroids, interrupt TIBSOVO until signs and symptoms are no longer severe. 

QTc Interval Prolongation: Patients treated with TIBSOVO can develop QT (QTc) prolongation and ventricular arrhythmias. One patient developed ventricular fibrillation attributed to TIBSOVO. Concomitant use of TIBSOVO with drugs known to prolong the QTc interval (e.g., anti-arrhythmic medicines, fluoroquinolones, triazole anti‑fungals, 5‑HT3 receptor antagonists) and CYP3A4 inhibitors may increase the risk of QTc interval prolongation. Conduct monitoring of electrocardiograms (ECGs) and electrolytes. In patients with congenital long QTc syndrome, congestive heart failure, electrolyte abnormalities, or in those who are taking medications known to prolong the QTc interval, more frequent monitoring may be necessary. 

Interrupt TIBSOVO if QTc increases to greater than 480 msec and less than 500 msec. Interrupt and reduce TIBSOVO if QTc increases to greater than 500 msec. Permanently discontinue TIBSOVO in patients who develop QTc interval prolongation with signs or symptoms of life-threatening arrhythmia. 

Guillain-Barré Syndrome: Guillain-Barré syndrome occurred in <1% (2/258) of patients treated with TIBSOVO in the clinical study. Monitor patients taking TIBSOVO for onset of new signs or symptoms of motor and/or sensory neuropathy such as unilateral or bilateral weakness, sensory alterations, paresthesias, or difficulty breathing. Permanently discontinue TIBSOVO in patients who are diagnosed with Guillain-Barré syndrome. 

ADVERSE REACTIONS

•The most common adverse reactions (≥20%) of any grade were fatigue (39%), leukocytosis (38%), arthralgia (36%), diarrhea (34%), dyspnea (33%), edema (32%), nausea (31%), mucositis (28%), electrocardiogram QT prolonged (26%), rash (26%), pyrexia (23%), cough (22%), and constipation (20%).

•The most frequently reported ≥Grade 3 adverse reactions (≥5%) were electrocardiogram QT prolonged (10%), dyspnea (9%), leukocytosis (8%), tumor lysis syndrome (6%), and differentiation syndrome (5%).

•Serious adverse reactions (≥5%) were differentiation syndrome (10%), leukocytosis (10%), and electrocardiogram QT prolonged (7%). There was one case of progressive multifocal leukoencephalopathy (PML).

DRUG INTERACTIONS

Strong or Moderate CYP3A4 Inhibitors: Reduce TIBSOVO dose with strong CYP3A4 inhibitors. Monitor patients for increased risk of QTc interval prolongation. 

Strong CYP3A4 Inducers: Avoid concomitant use with TIBSOVO. 

Sensitive CYP3A4 Substrates: Avoid concomitant use with TIBSOVO. 

QTc Prolonging Drugs: Avoid concomitant use with TIBSOVO. If co-administration is unavoidable, monitor patients for increased risk of QTc interval prolongation. 

LACTATION

Many drugs are excreted in human milk and because of the potential for adverse reactions in breastfed children, advise women not to breastfeed during treatment with TIBSOVO and for at least 1 month after the last dose. 

Please see full Prescribing Information, including Boxed WARNING.

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