The IDH1 inhibitor olutasidenib demonstrates a much longer duration of response than ivosidenib. One hypothesis is that olutasidenib's weaker affinity for wild-type IDH1 makes it a more selective inhibitor of the mutant protein, leading to more durable disease control.

An individual tumor can have hundreds of unique mutations, making it impossible to predict treatment response from a single genetic marker. This molecular chaos necessitates functional tests that measure a drug's actual effect on the patient's cells to determine the best therapy.

The IDH1 enzyme, part of the Krebs cycle, is mutated in up to 60% of chondrosarcomas, driving cancer growth. Drugs like Ivosidenib block this mutated enzyme, showing how basic metabolic pathways from textbooks are now at the forefront of targeted cancer therapy.

Cancer should be viewed not just as rogue cells, but as a complex system with its own supply chains and communication infrastructure. This perspective shift justifies novel therapies like Zelenorstat, which aim to dismantle this entire operating system by cutting its power source.

The same cancer-driving mutation behaves differently depending on the cell's internal "wiring." For example, a drug targeting a mutation works in melanoma but induces resistance in colorectal cancer due to a bypass pathway. This cellular context is why genetic data alone is insufficient.

Despite billions invested over 20 years in targeted and genome-based therapies, the real-world benefit to cancer patients has been minimal, helping only a small fraction of the population. This highlights a profound gap and the urgent need for new paradigms like functional precision oncology.

Traditional targeted cancer therapies inhibit or 'cool down' overactive pathways, like pumping brakes on a runaway car. Delpha Therapeutics employs a counterintuitive 'activation lethality' approach, further over-activating pathways to 'overheat the engine' and cause catastrophic failure in cancer cells—a fundamentally opposite but highly effective strategy.

Unlike therapies that only manage symptoms, the CALR antibody INCA033989 reduces hematopoietic stem and progenitor cell pools. This suggests the drug targets the root clonal source of the disease, indicating a potential for genuine disease modification rather than just killing off downstream cancer cells.

Therapies that rewire cancer cells to mature can cause "differentiation syndrome," a flood of immune cells. While a dangerous side effect, it's considered an on-target toxicity, confirming the drug is successfully restoring the cell's lost function and providing a real-time signal of its effectiveness.