Therapy for Diffuse Astrocytic and Oligodendroglial Tumors in Adults: ASCO-SNO Guideline Rapid Recommendation Update
Cet article présente une mise à jour des recommandations de l'"American Society of Clinical Oncology" et de la "Society for Neuro-Oncology" concernant le traitement des tumeurs astrocytaires et oligodendrogliales diffuses chez l'adulte
Background : In 2021, ASCO and the Society for Neuro-Oncology (SNO) jointly published a guideline regarding gliomas in adults.1 Recommendations 1.2 and 1.5 of that guideline stated that initial therapy with radiation and chemotherapy may be deferred in select patients with IDH-mutant WHO CNS grade 2 oligodendroglioma and astrocytoma.
On August 6, 2024, the US Food and Drug Administration (FDA) approved2 vorasidenib based on results of the INvestigating VorasiDenib In Glioma (INDIGO) trial3 for patients age ≥12 years with grade 2 astrocytoma or oligodendroglioma with a susceptible IDH1 or IDH2 mutation following surgery including biopsy, subtotal resection, or gross total resection. INDIGO data and the regulatory approval prompted consideration of a rapid recommendation update to answer the following question: can any other intervention be recommended in patients who have had initial radio-chemotherapy deferred?
Methods : A literature search was conducted for randomized controlled trials that met the selection criteria of the original guideline1 published between January 1, 2020, and October 15, 2024, that were not previously identified. The original guideline Expert Panel was reconvened to review new evidence from this search, including the INDIGO trial, and to review and approve the revised recommendation.
Evidence Review : The new literature search identified 688 potential articles, of which 62 were reviewed in full text. Sixteen new publications for previously identified trials and 27 new publications of 26 previously unknown trials were located. Of these, only one trial was identified that was relevant to the specific subpopulation addressed in this rapid update: the INDIGO trial.3 The remaining trials are briefly summarized in the Supplement. None of the other trials were considered to require a rapid recommendation update to the original guideline recommendations.
The published INDIGO trial outcomes are summarized in the Evidence Profile (Table 1). Vorasidenib was associated with significantly improved progression-free survival (PFS) and prolonged time to next intervention, but increased frequency of grade 3 or higher adverse events (mainly reversible and asymptomatic transaminitis) versus placebo. Patients were required to have at least one previous surgery with the most recent surgery occurring between 1 year and 5 years before random assignment, no other anticancer treatment for glioma, and be considered an appropriate candidate for a watch-and-wait approach. In addition, measurable nonenhancing disease (≥1 target lesion measuring ≥1 cm2) was required and any contrast enhancement had to be minimal, non-nodular, and nonmeasurable.
Journal of Clinical Oncology , article en libre accès 2025