Enasidenib

How it works

It inhibits the mutant IDH2 enzyme, reducing production of the oncometabolite 2-hydroxyglutarate and promoting differentiation of the leukaemic cells.

Prescribing in practice

• It can cause differentiation syndrome, which may be life-threatening, so clinicians and patients must recognise its features early and start corticosteroids promptly.
• Treatment is restricted to patients with a confirmed IDH2 mutation and should be supervised by clinicians experienced in leukaemia therapy.
• It can raise bilirubin and prolong the QT interval, so relevant biochemistry and the ECG should be checked.

Monitoring

Monitor the full blood count, liver biochemistry and electrolytes, and watch closely for signs of differentiation syndrome.

Counselling the patient

• Report fever, breathlessness, rapid weight gain or swelling without delay, as these may indicate differentiation syndrome.
• Do not stop the medicine on your own; discuss any troublesome effects with your team.

Evidence & guidelines

Mutant IDH2 inhibition is used in IDH2-mutated acute myeloid leukaemia in line with its licensed indication and supporting clinical trial evidence.