Ivosidenib for adults with IDH1‑mutated cancers and liver or kidney impairment.

A Phase 1, Multicenter, Open-Label, Safety and Pharmacokinetic Study of Orally Administered Ivosidenib in Participants With IDH1-Mutated Malignancies and Hepatic or Renal Impairment

This will test ivosidenib in adults with IDH1‑mutated cancers who have liver or kidney impairment to see how the drug is absorbed, processed, and tolerated.

Quick facts

• Phase: Phase 1
• Study type: Interventional
• Enrollment: 30 (estimated)
• Ages: 18 Years and up
• Sex: All
• Sponsor: Servier (Industry-sponsored)
• Locations: 19 sites (Atlanta, Georgia and 18 other locations)
• Trial ID: NCT07006688 on ClinicalTrials.gov

What this trial studies

This Phase 1 study enrolls adults with locally confirmed IDH1 R132‑mutated hematologic malignancies or non‑glioma solid tumors who have varying degrees of hepatic or renal impairment. Participants are assigned to one of five groups based on liver or kidney function and receive oral ivosidenib continuously in 28‑day cycles with scheduled PK/PD sampling and safety monitoring. Visits are frequent in Cycle 1 (days 1, 4, 8, 15, 22, 28), occur on days 1 and 15 in Cycles 2–3, and then on day 1 of each additional cycle, with a safety follow‑up about 30 days after treatment ends. The primary focus is to characterize pharmacokinetics, pharmacodynamics, safety, and tolerability to guide dosing in patients with organ impairment.

Who should consider this trial

Good fit: Adults with a locally confirmed IDH1 R132 mutation who have hematologic malignancies or non‑glioma solid tumors and who meet the study's defined hepatic or renal impairment and laboratory criteria are the intended participants.

Not a fit: Patients without an IDH1 mutation, those with glioma (which is excluded), or individuals with organ dysfunction outside the protocol's inclusion limits are unlikely to benefit from this study.

Why it matters

Potential benefit: If successful, the results could define safer dosing and broaden access to ivosidenib for patients with IDH1‑mutant cancers who have liver or kidney impairment.

How similar studies have performed: Ivosidenib is an approved, effective IDH1 inhibitor for certain AML patients, but dedicated PK/PD and safety data in patients with significant hepatic or renal impairment are limited.

Eligibility criteria

Inclusion Criteria:

* Participants with hematologic malignancies (including but not limited to acute myeloid leukemia (AML), myelodysplastic syndrome (MDS), myeloproliferative neoplasms, clonal cytopenia of unknown significance with a high-risk score \[CHRS ≥12.5\], chronic myelomonocytic leukemia, multiple myeloma, and non-Hodgkin's lymphoma) or solid tumors excluding glioma, with a locally confirmed IDH1 R132 mutation before Cycle 1 Day 1.
* Based on renal and hepatic function, participants within the:

  a. Moderate HI group, must have: i. Total bilirubin \>1.5 to 3 × upper limit of normal (ULN), not linked to Gilbert's disease, and any aspartate aminotransferase (AST) value, ii. Adequate renal function as evidenced by creatinine clearance (CrCl) ≥60 mL/min estimated according to the Cockcroft-Gault formula. b. Severe HI group, must have: i. Total bilirubin \>3 × ULN and any AST value, ii. Adequate renal function as evidenced by CrCl

  ≥60 mL/min estimated according to the Cockcroft-Gault formula. c. Severe RI group, must have: i. CrCl ≥15 to 29 mL/min estimated according to the Cockcroft-Gault formula, ii. Adequate hepatic function as evidenced by:
  1. Blood total bilirubin ≤1.5 × ULN, unless due to Gilbert's disease, where participants should have blood total bilirubin ≤3 × ULN;
  2. AST, alanine aminotransferase, and alkaline phosphatase ≤3.0 × ULN
* Participants of the control groups with adequate hepatic or renal function characterized as:

  1. Hepatic control group: Adequate hepatic function as evidenced by total bilirubin and AST ≤ULN, and normal to mild RI (CrCl ≥60 mL/min estimated according to the Cockcroft-Gault formula).
  2. Renal control group: Adequate renal function as evidenced by CrCl ≥90 mL/min (estimated according to the Cockcroft-Gault formula) and normal to mild HI (total bilirubin ≤1.5 × ULN, participants with Gilbert's disease should have blood total bilirubin ≤3 × ULN).
* Participants previously or currently treated with ivosidenib are eligible if treated at the 500 mg QD dose or if treated at the 250 mg QD dose due to strong cytochrome P450 (CYP)3A4 inhibitor intake. Participants with a hematologic malignancy on co-treatment with azacitidine are also eligible.
* WOCBP must agree to abstain from sexual intercourse or use 2 effective methods of birth control (a highly effective method and a barrier method) from the time of giving informed consent throughout the study and for 90 days after the last dose of ivosidenib. Hormonal contraception alone is not considered an acceptable method of contraception and should be combined with a barrier method.

Exclusion Criteria:

* Have undergone hematopoietic stem cell transplant (HSCT) within 60 days of the first dose of ivosidenib, or on immunosuppressive therapy post-HSCT at the time of screening, or with active acute or chronic graft-versus-host-disease (GVHD) requiring systemic therapy. (Participants with GVHD managed by minimal interventions \[a physiologic dose of steroids\] are permitted with the medical monitor's approval.)
* Have received systemic anticancer therapy (with the exception of azacitidine), investigational agent treatment, or radiotherapy \<14 days, or had surgery \<4 weeks before planned Cycle 1 Day 1 of ivosidenib, and/or did not recover from the AEs associated with these therapies and/or surgeries. In addition, the first dose of ivosidenib should not occur before a period of ≥5 half-lives of the study drug has elapsed.
* Have hematological diseases (other than AML or MDS) or solid tumors that are eligible for other treatments known to provide clinical benefit.
* Have received calcineurin inhibitors within 4 weeks prior to enrollment.
* Have significant active cardiac disease within 6 months before the start of ivosidenib, including NYHA Class III or IV congestive heart failure, myocardial infarction, unstable angina, and/or stroke.
* Use of any medications that are known to prolong the QT interval unless they can be transferred to other medications within ≥5 half-lives before dosing or unless the medications can be properly monitored during the study. (If equivalent medication is not available, QTcF should be closely monitored).
* Planned use of any strong CYP3A4 inducer or sensitive CYP3A4 substrate with a narrow therapeutic window or certain antifungals that are CYP3A4 substrates while the participant is receiving ivosidenib. Participants who are taking these medications must have the minimum washout period of ≥5 half-lives before the first dose of ivosidenib and not take the medications for the duration of their participation in the study.
* Have known active inflammatory gastrointestinal disease, chronic diarrhea, previous gastric resection or laparoscopic gastric banding, short-gut syndrome, gastroparesis, or other active conditions that limit the ingestion or gastrointestinal absorption of drugs administered orally. Gastroesophageal reflux disease under medical treatment is allowed (assuming no drug interaction potential).
* Have a known familial history of sudden death or polymorphic ventricular arrhythmia.

Where this trial is running

Atlanta, Georgia and 18 other locations

• Emory University — Atlanta, Georgia, United States (Recruiting)
• MD Anderson — Houston, Texas, United States (Not_yet_recruiting)
• Icon Cancer Centre — South Brisbane, Queensland, Australia (Recruiting)
• Royal Adelaide Hospital — Adelaide, South Australia, Australia (Recruiting)
• Hospital de Base de Sao Jose do Rio Preto — São José do Rio Preto, São Paulo, Brazil (Recruiting)
• Instituto do Cancer do Estado de Sao Paulo — São Paulo, Brazil (Recruiting)
• Fakultni nemocnice v Motole FN Motol — Prague, HlavnÃ- Mesto Praha, Czechia (Recruiting)
• University Hospital Brno — Brno, Czechia (Withdrawn)
• Fakultni nemocnice Ostrava — Ostrava, Czechia (Recruiting)
• Vseobecna fakultni nemocnice v Praze — Prague, Czechia (Not_yet_recruiting)
• Seoul National University Bundang Hospital — Seongnam-si, Gyeonggi-do, South Korea (Recruiting)
• Seoul National University Hospital — Seoul, South Korea (Recruiting)
• Severence Hospital, Yonsei University Health Systems — Seoul, South Korea (Recruiting)
• Asan Medical Center — Seoul, South Korea (Recruiting)
• START - Hospital HM Nou Delfos — Barcelona, Spain (Recruiting)
• Hospital Universitari Vall d'Hebron — Barcelona, Spain (Not_yet_recruiting)
• START Madrid - Fundacion Jimenez Diaz — Madrid, Spain (Recruiting)
• Hospital Universitario 12 de Octubre — Madrid, Spain (Recruiting)
• START Madrid Centro Oncologico Clara Campal Sanchinarro Univesrity Hospital — Madrid, Spain (Recruiting)

Study contacts

• Study coordinator: Institut de Recherches Internationales Servier (I.R.I.S.), Clinical Studies Department

Conditions IDH1-Mutated Malignancies