Treatment Name: Enasidenib (IDHIFA®)
How does enasidenib (IDHIFA®) work?
A protein known as isocitrate dehydrogenase-2, commonly referred to as “IDH2”, can become mutated within immature myeloid white blood cells. A mutated IDH2 protein can prevent these cells from maturing into normal functional cells, and cause them to accumulate leading to acute myeloid leukemia (AML).
Enasidenib (IDHIFA®) is designed to bind to mutated IDH2 proteins in myeloid leukemia cells. By blocking the function of the mutated IDH2 proteins, enasidenib allows the cells to mature properly. Patients without a known IDH2 mutation may not benefit from enasidenib.
Goals of therapy:
Enasidenib is given to help increase normal blood cell counts such as red blood cells and platelets if they are low, decrease the risk of infection, decrease the amount of blood transfusions needed, and decrease the risk of bleeding. It is not commonly given with the goal of cure. In clinical trials, 11% of patients taking enasidenib were able to receive a potentially curative bone marrow transplant.
- Usual Enasidenib (IDHIFA®) starting dose: 100 mg oral tablet by mouth once daily
Enasidenib is usually taken at home until the drug no longer works or until unacceptable side effects occur. It may take as long as six months of therapy with enasidenib to see a response to treatment.
Note: Individual doses may vary based upon your Doctor's recommendation, or drug availability. The 50 mg tablet may be prescribed if a dose reduction is recommended by your doctor.
In clinical studies, the most commonly reported side effects of enasidenib (IDHIFA®) are shown here:
- Increase in serum bilirubin (81%)
- Serum calcium decrease (74%)
- Nausea (50%)
- Diarrhea (43%)
- Serum potassium decrease (41%)
- Vomiting (34%)
- Decreased appetite (34%)
- Serum phosphorous decrease (27%)
- Differentiation syndrome (14%)
- Altered taste (12%)
- Increased white blood cell count (12%)
- Tumor lysis syndrome (6%)
*Important note: Contact your doctor or go to the nearest emergency room immediately if you are experiencing any signs or symptoms of differentiation syndrome such as fever, cough, trouble breathing, bone pain, rapid weight gain, or swelling in your arms or legs.
If differentiation syndrome is suspected, a potent steroid such as dexamethasone 10 mg every 12 hours is usually given until improvement, then slowly decreased to make sure the symptoms do not come back. Treatment with enasidenib may need to be temporarily suspended. Differentiation syndrome may occur as early as 10 days after starting therapy with enasidenib or as late as 5 months after starting therapy. Hospitalization may be required to manage symptoms of differentiation syndrome.
Roughly 43% of patients require at least one temporary interruption of treatment and 17% of patients discontinue treatment permanently due to unacceptable side effects.
How often is monitoring needed?
Labs (blood tests) may be checked before treatment, at least every 2 weeks during the first 3 months of treatment (maybe more often), then periodically thereafter until stable. Labs often include: Complete Blood Count (CBC), Comprehensive Metabolic Panel (CMP), lactate dehydrogenase (LDH), serum phosphorus, uric acid, plus any others your doctor may order.
How often is imaging needed?
Imaging may be checked during treatment if there is concern for an infection, bleeding, or a blood clot. Imaging may include: X-rays, magnetic resonance imaging (MRI), or computerized tomography (CT) scans.
How might blood test results/imaging affect treatment?
Depending upon the results, your doctor may advise to continue enasidenib as planned, reduce the dose of future treatments, temporarily delay treatment until the side effect goes away, or switch to an alternative therapy.
Tumor lysis labs may be done more frequently when first stating therapy to protect your heart and kidneys from rapidly dying cancer cells.
- Approximately 12% of patients will experience an increase in white blood cell count (WBC) that is not due an infection while taking enasidenib. If the WBC rises to a high range (greater than 30 x 109/L) and there is no evidence of an infection, a medication known as hydroxyurea (Hydrea®) may be given to lower the WBC. If the WBC does not improve with hydroxyurea, treatment with enasidenib may need to be temporarily suspended until the WBC improves
- Allopurinol may be prescribed to help prevent tumor lysis syndrome
- Enasidenib may cause an increase in blood bilirubin, a common blood test used to monitor the function of your liver. In most cases, increases in blood bilirubin are due to enasidenib affecting the removal of bilirubin from your body and not because your liver is being damaged. Contact your doctor immediately if you notice yellowing of your skin or eyes which may be a sign that your bilirubin is increased
- Be sure to keep enasidenib tablets in the original bottle and do not store in places where there is a lot of moisture such as the bathroom. Do not take tablets out of the bottle until right before taking your dose
- A pharmacist should ALWAYS review your medication list to ensure that drug interactions are prevented or managed appropriately
- Clinical trials may exist for AML. Ask your doctor if any studies are currently enrolling in your area. If not, go to clinicaltrials.gov to search for other centers offering study medications
Patient Assistance & Co-payment Coverage
Patients under the age of 65 years, or those with private insurance plans:
If you have insurance and are looking for patient assistance or copay assistance for Enasidenib (IDHIFA®), we have provided links that may help.
Visit our Patient Assistance page and click the links to various patient assistance programs for help paying for Enasidenib (IDHIFA®). Depending upon your income, they may be able to help cover the cost of:
For Branded medications (may be available for generic medications too), check with the manufacturer to determine if a co-pay card is offered and if it could reduce your monthly copay.
- If you are uninsured, check with the manufacturer to determine if you are eligible to receive medication at no cost.
Medicare and Medicaid patients (Patients 65 years or older):
The clinic providing treatment will likely pre-authorize medications and immune therapies such as Enasidenib (IDHIFA®) and are the best source to help you understand drug cost.
- Ask to speak with a patient assistance technician or financial counselor at the clinic or hospital administering this therapy.
What is Emotional Wellness?
Emotional wellness is having a positive outlook balanced with a realistic understanding of current life events. This requires both an awareness and acceptance of your emotions. It is with this knowledge that you can develop a plan to take the necessary actions to positively impact your life.
Emotional wellness uses an ongoing process to continually reflect on the stressors of life in a constructive manner to move forward and create happiness.
Because emotional wellness is deeply connected with physical, social, and spiritual wellness, pursuing it often becomes particularly difficult in times of major illness. Despite this difficulty, working toward emotional wellness has been connected to improved treatment outcomes and a higher likelihood of achieving goals of therapy.
Learn more about pursuing emotional wellness while receiving treatment with Enasidenib (IDHIFA®)