The Biological Significance of Tumor Grade, Age, Enhancement, and Extent of Resection in Idh-Mutant Gliomas: How Should They Inform Treatment Decisions in the Era of IDH Inhibitors?

Authors

Martin J van den Bent
Pim J French
Daniel Brat
Joerg C Tonn
Mehdi Touat
Benjamin M Ellingson
Robert J Young
Johan Pallud
Andreas von Deimling
Felix Sahm
Dominique Figarella Branger
Raymond Y Huang
Michael Weller
Ingo K Mellinghoff
Tim F Cloughsey
Jason T Huse
Kenneth Aldape
Guido Reifenberger
Gilbert Youssef
Philipp Karschnia
Houtan Noushmehr
Katherine B Peters
Francois Ducray
Matthias Preusser
Patrick Y Wen

Publication Date

10-3-2024

Journal

Neuro-Oncology

Abstract

The 2016 and 2021 World Health Organization 2021 Classification of central nervous system tumors have resulted in a major improvement in the classification of isocitrate dehydrogenase (IDH)-mutant gliomas. With more effective treatments many patients experience prolonged survival. However, treatment guidelines are often still based on information from historical series comprising both patients with IDH wild-type and IDH-mutant tumors. They provide recommendations for radiotherapy and chemotherapy for so-called high-risk patients, usually based on residual tumor after surgery and age over 40. More up-to-date studies give a better insight into clinical, radiological, and molecular factors associated with the outcome of patients with IDH-mutant glioma. These insights should be used today for risk stratification and for treatment decisions. In many patients with IDH-mutant grades 2 and 3 glioma, if carefully monitored postponing radiotherapy and chemotherapy is safe, and will not jeopardize the overall outcome of patients. With the INDIGO trial showing patient benefit from the IDH inhibitor vorasidenib, there is a sizable population in which it seems reasonable to try this class of agents before recommending radio-chemotherapy with its delayed adverse event profile affecting quality of survival. Ongoing trials should help to further identify the patients that are benefiting from this treatment.

Keywords

Humans, Isocitrate Dehydrogenase, Glioma, Brain Neoplasms, Mutation, Neoplasm Grading, Age Factors, Clinical Decision-Making, Enzyme Inhibitors, WHO brain tumor classification, astrocytoma IDH-mutant, oligodendroglioma IDH-mutant and 1p/19q codeleted, prognosis, vorasidenib

Comments

This article has been corrected. See Neuro Oncol. 2024 Sep 14;26(12):2397.

DOI

10.1093/neuonc/noae107

PMID

38912846

PMCID

PMC11449017

PubMedCentral® Posted Date

6-24-2024

PubMedCentral® Full Text Version

Post-print

Published Open-Access

yes