Nimish A Mohile1, Hans Messersmith2, Na Tosha Gatson3,4, Andreas F Hottinger5, Andrew Lassman6, Jordan Morton7, Douglas Ney8, Phioanh Leia Nghiemphu9, Adriana Olar10, Jeffery Olson11, James Perry12, Jana Portnow13, David Schiff14, Anne Shannon15, Helen A Shih16, Roy Strowd17, Martin van den Bent18, Mateo Ziu19, Jaishri Blakeley20. 1. Department of Neurology and Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY. 2. American Society of Clinical Oncology, Alexandria, VA. 3. Banner MD Anderson Cancer Center, Phoenix, AZ. 4. Geisinger Neuroscience Institute. Danville, PA. 5. Departments of Clinical Neurosciences and Oncology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland. 6. Columbia University Medical Center, New York, NY. 7. University of Oklahoma Health Sciences, Oklahoma City, OK. 8. University of Colorado School of Medicine, Aurora, CO. 9. UCLA David Geffen School of Medicine, Los Angeles, CA. 10. Nomix Laboratories, Denver, CO. 11. Emory University, Atlanta, GA. 12. Sunnybrook Health Sciences Center, Toronto, Ontario, Canada. 13. City of Hope National Medical Center, Duarte, CA. 14. University of Virginia Medical Center, Charlottesville, VA. 15. Patient Representative, Honeoye Falls, NY. 16. Massachusetts General Hospital, Boston, MA. 17. Wake Forest Baptist Health Medical Center, Winston-Salem, NC. 18. The Brain Tumor Center at Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands. 19. INOVA Neurosciences and Inova Schar Cancer Institute, Falls Church, VA. 20. Johns Hopkins University School of Medicine, Baltimore, MD.
Abstract
PURPOSE: To provide guidance to clinicians regarding therapy for diffuse astrocytic and oligodendroglial tumors in adults. METHODS: ASCO and the Society for Neuro-Oncology convened an Expert Panel and conducted a systematic review of the literature. RESULTS: Fifty-nine randomized trials focusing on therapeutic management were identified. RECOMMENDATIONS: Adults with newly diagnosed oligodendroglioma, isocitrate dehydrogenase (IDH)-mutant, 1p19q codeleted CNS WHO grade 2 and 3 should be offered radiation therapy (RT) and procarbazine, lomustine, and vincristine (PCV). Temozolomide (TMZ) is a reasonable alternative for patients who may not tolerate PCV, but no high-level evidence supports upfront TMZ in this setting. People with newly diagnosed astrocytoma, IDH-mutant, 1p19q non-codeleted CNS WHO grade 2 should be offered RT with adjuvant chemotherapy (TMZ or PCV). People with astrocytoma, IDH-mutant, 1p19q non-codeleted CNS WHO grade 3 should be offered RT and adjuvant TMZ. People with astrocytoma, IDH-mutant, CNS WHO grade 4 may follow recommendations for either astrocytoma, IDH-mutant, 1p19q non-codeleted CNS WHO grade 3 or glioblastoma, IDH-wildtype, CNS WHO grade 4. Concurrent TMZ and RT should be offered to patients with newly diagnosed glioblastoma, IDH-wildtype, CNS WHO grade 4 followed by 6 months of adjuvant TMZ. Alternating electric field therapy, approved by the US Food and Drug Administration, should be considered for these patients. Bevacizumab is not recommended. In situations in which the benefits of 6-week RT plus TMZ may not outweigh the harms, hypofractionated RT plus TMZ is reasonable. In patients age ≥ 60 to ≥ 70 years, with poor performance status or for whom toxicity or prognosis are concerns, best supportive care alone, RT alone (for MGMT promoter unmethylated tumors), or TMZ alone (for MGMT promoter methylated tumors) are reasonable treatment options. Additional information is available at www.asco.org/neurooncology-guidelines.
PURPOSE: To provide guidance to clinicians regarding therapy for diffuse astrocytic and oligodendroglial tumors in adults. METHODS: ASCO and the Society for Neuro-Oncology convened an Expert Panel and conducted a systematic review of the literature. RESULTS: Fifty-nine randomized trials focusing on therapeutic management were identified. RECOMMENDATIONS: Adults with newly diagnosed oligodendroglioma, isocitrate dehydrogenase (IDH)-mutant, 1p19q codeleted CNS WHO grade 2 and 3 should be offered radiation therapy (RT) and procarbazine, lomustine, and vincristine (PCV). Temozolomide (TMZ) is a reasonable alternative for patients who may not tolerate PCV, but no high-level evidence supports upfront TMZ in this setting. People with newly diagnosed astrocytoma, IDH-mutant, 1p19q non-codeleted CNS WHO grade 2 should be offered RT with adjuvant chemotherapy (TMZ or PCV). People with astrocytoma, IDH-mutant, 1p19q non-codeleted CNS WHO grade 3 should be offered RT and adjuvant TMZ. People with astrocytoma, IDH-mutant, CNS WHO grade 4 may follow recommendations for either astrocytoma, IDH-mutant, 1p19q non-codeleted CNS WHO grade 3 or glioblastoma, IDH-wildtype, CNS WHO grade 4. Concurrent TMZ and RT should be offered to patients with newly diagnosed glioblastoma, IDH-wildtype, CNS WHO grade 4 followed by 6 months of adjuvant TMZ. Alternating electric field therapy, approved by the US Food and Drug Administration, should be considered for these patients. Bevacizumab is not recommended. In situations in which the benefits of 6-week RT plus TMZ may not outweigh the harms, hypofractionated RT plus TMZ is reasonable. In patients age ≥ 60 to ≥ 70 years, with poor performance status or for whom toxicity or prognosis are concerns, best supportive care alone, RT alone (for MGMT promoter unmethylated tumors), or TMZ alone (for MGMT promoter methylated tumors) are reasonable treatment options. Additional information is available at www.asco.org/neurooncology-guidelines.
Authors: Mary Jane Lim-Fat; Maria Macdonald; Sarah Lapointe; Seth Andrew Climans; Chantel Cacciotti; Manik Chahal; Sebastien Perreault; Derek S Tsang; Andrew Gao; Stephen Yip; Julia Keith; Julie Bennett; Vijay Ramaswamy; Jay Detsky; Uri Tabori; Sunit Das; Cynthia Hawkins Journal: Front Oncol Date: 2022-09-23 Impact factor: 5.738