Enasidenib is a targeted therapeutic agent primarily used for patients with specific types of acute myeloid leukemia (AML). As an isocitrate dehydrogenase-2 (IDH2) inhibitor, it provides a new treatment option for patients with relapsed or refractory AML through its unique mechanism of action.

How Effective is Enasidenib in Treatment?

Characteristics of Pharmacological Action

As an IDH2 enzyme inhibitor, enasidenib is unique in its ability to selectively act on mutant IDH2 variants.

By inhibiting the activity of mutant IDH2 enzyme, the drug reduces the level of 2-hydroxyglutarate (2-HG), thereby inducing bone marrow differentiation.

This targeted mechanism of action enables it to exhibit specific efficacy in the treatment of AML with IDH2 mutation.

Hematological Improvements

Changes in transfusion requirements can be observed during enasidenib treatment.

A significant proportion of patients who were transfusion-dependent at baseline can transition to a transfusion-independent state.

For patients who were already transfusion-independent before treatment, most can maintain this state.

This change reflects the drug's role in improving patients' hematological indicators.

Population Suitable for Enasidenib

Core Indicated Population

Enasidenib is explicitly indicated for adult patients with relapsed or refractory acute myeloid leukemia who have been confirmed to have IDH2 mutation by an FDA-approved detection method.

Before medication administration, the IDH2 mutation status must be confirmed through molecular testing, which is a prerequisite for the drug to exert its efficacy.

For the test, blood or bone marrow samples can be used for mutation analysis.

Medication Monitoring for Enasidenib

Key Focuses for Adverse Reaction Monitoring

During enasidenib treatment, special vigilance must be paid to the occurrence of differentiation syndrome, which is a potentially life-threatening severe adverse reaction.

Its clinical manifestations include multi-system symptoms such as fever, dyspnea, pulmonary infiltrates, and rapid weight gain.

Once this syndrome is suspected, corticosteroid treatment and hemodynamic monitoring should be initiated immediately.

Non-infectious leukocytosis is also an important adverse reaction that requires monitoring, and intervention measures may be necessary.

Gastrointestinal reactions such as nausea, vomiting, and diarrhea are common but usually mild, and can be alleviated through symptomatic treatment.

Requirements for Laboratory Monitoring

During treatment, regular monitoring of hematological indicators and blood biochemical values is required, and the monitoring frequency should be increased especially in the early stage of treatment.

Special attention should be paid to changes in bilirubin levels; this may be caused by the drug's inhibition of bilirubin metabolism pathways, rather than a sign of liver injury.

Electrolyte balance and renal function also need to be routinely monitored to prevent complications such as tumor lysis syndrome.