INNV-03. Reproductive health considerations for IDH-mutant glioma patients considering IDH inhibitor therapy: a retrospective cohort study

Reproductive health considerations are critical to patients with IDH mutant (IDHm) glioma as they are mainly diagnosed during their reproductive years. Given the recent introduction of IDH inhibitors (IDHi) for the treatment of IDHm glioma, we review our current understanding of reproductive implications of IDHi therapy, and report rates of reproductive health conversations when discussing IDHi therapy. We searched the literature for studies evaluating the effects of IDHi therapy on reproductive health. We additionally retrospectively collected clinical data from reproductive-age patients with IDHm glioma treated at Dana-Farber Cancer Institute and Massachusetts General Brigham who received or were considered for IDHi therapy between 2018-2024. Medical records were reviewed for documentation of fertility and contraception discussions at the time of IDHi consideration. Of 119 patients considered for IDHi therapy, 54 (45%) had no documented fertility conversation in relation to IDHi and 92 (77%) had no documented contraception conversation. Among females, 30 (65%) had a documented fertility conversation, whereas among men, 49% had such a conversation. Patients who had a documented fertility conversation were younger than those who did not (median 31 versus 34yo). We summarize current knowledge regarding the reproductive effects of IDHi therapy. Our institutional data provide evidence that conversations regarding IDHi reproductive risks are not generally documented, suggesting limited or no discussion of these considerations. We recommend routinely discussing and documenting reproductive health conversations before initiating IDHi therapy. Future studies are required to better understand the impact of IDHi therapy on fertility and fetal development.