Therapy for Diffuse Astrocytic and Oligodendroglial Tumors in Adults

Publication Date: December 13, 2021
Last Updated: September 2, 2022

Treatment

IDH-mutant Astrocytic and Oligodendroglial Tumors

Oligodendroglioma, IDH-mutant, 1p/19q co-deleted, CNS WHO grade 2

Recommendation 1.1
People with oligodendroglioma, IDH-mutant, 1p/19q co-deleted, CNS WHO grade 2 should be offered radiation in combination with PCV. ( EB , I , B , S )
3336
Temozolomide is a reasonable alternative to PCV when toxicity is a concern. ( IC , L , , W )
3336
Recommendation 1.2
Within the group of people with oligodendroglioma, IDH-mutant, 1p/19q co-deleted, CNS WHO grade 2, initial therapy may be deferred until radiographic or symptomatic progression in some people with positive prognostic factors (e.g., complete resection and younger age) or concerns about toxicity. See guideline for more details. ( IC , L , , W )
3336

Oligodendroglioma, IDH-mutant, 1p/19q co-deleted, CNS WHO grade 3 (former anaplastic oligodendroglioma)

Recommendation 1.3
People with oligodendroglioma, IDH-mutant, 1p/19q co-deleted, CNS WHO grade 3 should be offered radiation therapy in combination with PCV. ( EB , I , B , S )
3336
Temozolomide is a reasonable alternative to PCV when toxicity is a concern. ( IC , L , , W )
3336

Astrocytoma, IDH-mutant, 1p/19q non-codeleted, CNS WHO grade 2 (former diffuse astrocytoma)

Recommendation 1.4
People with astrocytoma, IDH-mutant, 1p/19q non-codeleted, CNS WHO grade 2 (low grade diffuse glioma) should be offered radiation therapy with adjuvant chemotherapy (temozolomide or PCV). ( EB , I , B , S )
(IC regarding temozolomide)
3336
Recommendation 1.5
In astrocytoma, IDH-mutant, 1p/19q non-codeleted, CNS WHO grade 2, initial therapy may be deferred until radiographic or symptomatic progression in some people with positive prognostic factors (e.g., complete resection, younger age) or concerns about short- and long- term toxicity given the natural history of the disease. See guideline for more details. ( IC , I , B , M )
3336

Astrocytoma, IDH-mutant, 1p/19q non-codeleted, CNS WHO grade 2 (former diffuse astrocytoma)

Recommendation 1.6
People with astrocytoma, IDH-mutant, 1p/19q non-codeleted CNS WHO grade 3 should be offered radiation therapy with adjuvant temozolomide. ( IC , I , B , M )
3336

Astrocytoma, IDH-mutant, CNS WHO grade 4 (former IDH-mutant glioblastoma)

Recommendation 1.7
People with astrocytoma, IDH-mutant CNS WHO grade 4 may be treated like an astrocytoma, IDH-mutant, non-codeleted, CNS WHO grade 3 (former anaplastic astrocytoma) (see Recommendation 1.6) or like a glioblastoma, IDH-wildtype, CNS WHO grade 4 (former IDH-wildtype glioblastoma) (see Recommendation 2.2). ( IC , L , , W )
3336
Glioblastoma and Other IDH-wildtype Diffuse Glioma
Recommendation 2.1
People with astrocytomas, IDH-wildtype, CNS WHO grade 2 or 3 may be treated according to recommendations for glioblastoma, IDH-wildtype, CNS WHO grade 4 found in this guideline. ( IC , , , W )
(Evidence Quality: Very Low)
3336
Recommendation 2.2
Concurrent temozolomide and radiation therapy should be offered to people with newly diagnosed glioblastoma, IDH-wildtype, CNS WHO grade 4. ( EB , I , B , S )

Qualifying Statement: With the exception of studies addressing glioblastoma diagnosis in people of older age or poor performance status, no prospective, randomized evidence provides a sufficient basis to guide decision-making based on MGMT promotor methylation status.

3336
Recommendation 2.3
Six months of adjuvant temozolomide should be offered to people with newly diagnosed glioblastoma, IDH-wildtype, CNS WHO grade 4 who have received concurrent radiation therapy plus temozolomide. ( EB , I , B , S )
3336
Recommendation 2.4
Alternating electric field therapy may be added to adjuvant temozolomide in people with newly diagnosed supratentorial glioblastoma, IDH-wildtype, CNS WHO grade 4 who have completed chemoradiation therapy. ( EB , I , B , W )
3336
Recommendation 2.5
Bevacizumab is NOT recommended for people with newly diagnosed glioblastoma, IDH-wildtype, CNS WHO grade 4. ( EB , I , U, W )
3336
Recommendation 2.6
In people with glioblastoma, IDH-wildtype, CNS WHO grade 4 where the expected survival benefits of a six-week radiation course combined with temozolomide may not outweigh the harms, hypofractionated radiation therapy combined with temozolomide is a reasonable alternative. See guideline for further explanation. ( EB , I , B , W )
3336
Recommendation 2.7
In people with glioblastoma, IDH-wildtype, CNS WHO grade 4 with older age, poor performance status or with concerns about toxicity or prognosis, best supportive care alone, hypofractionated radiation therapy alone (for MGMT promotor unmethylated tumors) or temozolomide alone (for MGMT promotor methylated tumors) are reasonable options. See Clinical Interpretation for further explanation. ( IC , L , , W )
3336
Recommendation 2.8
No recommendation for or against any therapeutic strategy can be made for treatment of recurrent glioblastoma, IDH-wildtype, CNS WHO grade 4. ( IC , L , , )
3336
People with recurrent glioblastoma should be referred for participation in a clinical trial where possible. ( IC , L , , S )
3336
Recommendation 2.9
No recommendation for or against any therapeutic strategy can be made for treatment of diffuse midline glioma. ( IC , L , , )
3336
People with diffuse midline glioma should be referred for participation in a clinical trial when possible. ( IC , L , , S )
3336

Recommendation Grading

Overview

Title

Therapy for Diffuse Astrocytic and Oligodendroglial Tumors in Adults

Authoring Organization

Publication Month/Year

December 13, 2021

Last Updated Month/Year

February 12, 2024

Document Type

Guideline

Country of Publication

US

Document Objectives

To provide guidance to clinicians regarding therapy for diffuse astrocytic and oligodendroglial tumors in adults.

Target Patient Population

Adult people with glioma who have received maximal safe surgical resection

Target Provider Population

Oncologists (medical, radiation, neuro) and neurologists who provide care to people with glioma

Inclusion Criteria

Male, Female, Adult, Older adult

Health Care Settings

Ambulatory, Hospital, Outpatient, Radiology services, Operating and recovery room

Intended Users

Nurse, nurse practitioner, physician, physician assistant

Scope

Treatment, Management

Diseases/Conditions (MeSH)

D005910 - Glioma, D009837 - Oligodendroglioma

Keywords

brain cancer, glioma, oligodendroglioma, astrocytic, tumor

Source Citation

Mohile NA, Messersmith H, Gatson NT, Hottinger AF, Lassman A, Morton J, Ney D, Nghiemphu PL, Olar A, Olson J, Perry J, Portnow J, Schiff D, Shannon A, Shih HA, Strowd R, van den Bent M, Ziu M, Blakeley J. Therapy for Diffuse Astrocytic and Oligodendroglial Tumors in Adults: ASCO-SNO Guideline. J Clin Oncol. 2021 Dec 13:JCO2102036. doi: 10.1200/JCO.21.02036. Epub ahead of print. PMID: 34898238.

Supplemental Methodology Resources

Data Supplement, Evidence Tables

Methodology

Number of Source Documents
109
Literature Search Start Date
January 1, 2001
Literature Search End Date
August 17, 2020