Point mutations in
isocitrate dehydrogenase 1 (IDH1) result in conversion of α-ketoglutarate to the oncometabolite,
d-2-hydroxyglutarate (2-HG).
Ivosidenib is a once daily (QD), orally available, potent, mutant
isocitrate dehydrogenase 1 (mIDH1) inhibitor approved for the treatment of patients with relapsed or refractory
acute myeloid leukemia (AML) and intensive
chemotherapy-ineligible newly diagnosed AML, with a susceptible IDH1 mutation. We characterized the protein binding, metabolism, metabolites, cell permeability, and drug-drug interaction potential of
ivosidenib in humans, monkeys, dogs, rats, and/or mice in in vitro experiments. In vivo pharmacokinetic (PK) profiling and assessment of drug distribution and excretion was undertaken in rats, dogs, and monkeys administered single-dose
ivosidenib. The PK/pharmacodynamic (PD) relationship between
ivosidenib and 2-HG was analyzed in an mIDH1 xenograft mouse model.
Ivosidenib was well absorbed, showed low clearance, and moderate to long terminal half-life (5.3-18.5 hours) in rats, dogs, and monkeys. Brain to plasma exposure ratio was low (2.3%),
plasma protein binding was high, and oxidative metabolism was the major elimination pathway.
Ivosidenib had high cell permeability and was identified as a substrate for
P-glycoprotein. There was moderate induction of
cytochrome P450 (
P450) enzymes CYP3A4 and
CYP2B6 but minimal P450 inhibition or autoinduction.
Tumor 2-HG reduction appeared to be dose- and drug-exposure-dependent.
Ivosidenib showed a favorable PK profile in several animal species, along with a clear PK/PD relationship demonstrating 2-HG inhibition that translated well to patients with AML. SIGNIFICANCE STATEMENT:
Ivosidenib is a mutant IDH1 (mIDH1) inhibitor approved for the treatment of certain patients with mIDH1
acute myeloid leukemia. In Sprague-Dawley rats, beagle dogs, and cynomolgus monkeys,
ivosidenib demonstrated a favorable pharmacokinetic profile, and in female BALB/c mice showed clear dose- and exposure-dependent inhibition of the oncometabolite,
d-2-hydroxyglutarate, which is present at abnormal levels in mIDH1
tumors. These findings led to the further development of
ivosidenib and are consistent with data from patients with mIDH1
cancers and healthy participants.