In late April of 2025, the American Society of Clinical Oncology provided updated guidelines regarding its Therapy for Diffuse Astrocytic and Oligodendroglial Tumors in Adults guidelines. The updated information is in response to practice-changing data regarding the 2024 FDA approval of vorasidenib.
Guidelines Referenced:
- Therapy for Diffuse Astrocytic and Oligodendroglial Tumors in Adults: ASCO-SNO Guideline
- Published: December 13, 2021
- Therapy for Diffuse Astrocytic and Oligodendroglial Tumors in Adults: ASCO-SNO Guideline Rapid Recommendation Update
- Published: April 29, 2025
Guideline Updates:
| Topic | 2025 Recommendations | 2021 Recommendations |
|---|---|---|
| Oligodendroglioma, IDH-mutant, 1p19q codeleted, central nervous system (CNS) World Health Organization (WHO) grade 2 | 1.1. People with oligodendroglioma, IDH-mutant, 1p19q codeleted, CNS WHO grade 2 should be offered radiation in combination with procarbazine, lomustine, and vincristine (PCV). Temozolomide is a reasonable alternative to PCV when toxicity is a concern. 1.2. (Updated) Within the group of people with oligodendroglioma, IDH-mutant, 1p19q codeleted, CNS WHO grade 2, initial radiation therapy and chemotherapy (with PCV or temozolomide) may be deferred until radiographic or symptomatic progression in some people with favorable prognostic factors (e.g., complete resection and younger age) or concerns about toxicity. 1.2.1. (New) Vorasidenib may be offered to people with oligodendroglioma, IDH-mutant, 1p19q codeleted, CNS WHO grade 2, where, after one or more surgeries, further treatment with radiation and chemotherapy has been or can be deferred. | 1.1. People with oligodendroglioma, IDH-mutant, 1p19q codeleted, CNS WHO grade 2 should be offered radiation in combination with procarbazine, lomustine, and vincristine (PCV). Temozolomide (TMZ) is a reasonable alternative to PCV when toxicity is a concern. 1.2. Within the group of people with oligodendroglioma, IDH-mutant, 1p19q codeleted, CNS WHO grade 2, initial therapy may be deferred until radiographic or symptomatic progression in some people with positive prognostic factors (eg, complete resection and younger age) or concerns about toxicity. |
| Oligodendroglioma, IDH-mutant, 1p19q codeleted, CNS WHO grade 3 (formerly anaplastic oligodendroglioma) | 1.3. People with oligodendroglioma, IDH-mutant, 1p19q codeleted, CNS WHO grade 3 should be offered radiation therapy in combination with PCV. TMZ is a reasonable alternative to PCV when toxicity is a concern. | 1.3. People with oligodendroglioma, IDH-mutant, 1p19q codeleted, CNS WHO grade 3 should be offered radiation therapy in combination with PCV. TMZ is a reasonable alternative to PCV when toxicity is a concern. |
| Astrocytoma, IDH-mutant, 1p19q non-codeleted, CNS WHO grade 2 (former diffuse astrocytoma) | 1.4. People with astrocytoma, IDH-mutant, 1p19q non-codeleted, CNS WHO grade 2 (low grade diffuse glioma) should be offered radiation therapy with adjuvant chemotherapy (temozolomide or PCV). 1.5. (Updated) In astrocytoma, IDH-mutant, 1p19q non-codeleted, CNS WHO grade 2, initial radiation therapy and chemotherapy (with temozolomide or PCV) may be deferred until radiographic or symptomatic progression in some people with favorable prognostic factors (e.g., complete resection, younger age) or concerns about short- and long-term toxicity given the natural history of the disease. 1.5.1. (New) Vorasidenib may be offered to people with astrocytoma, IDH-mutant, 1p19q non-codeleted, CNS WHO grade 2, where, after one or more surgeries, further treatment with radiation and chemotherapy has been or can be deferred. | 1.4. People with astrocytoma, IDH-mutant, 1p19q non-codeleted, CNS WHO grade 2 (low-grade diffuse glioma) should be offered RT with adjuvant chemotherapy (TMZ or PCV). 1.5. In astrocytoma, IDH-mutant, 1p19q non-codeleted, CNS WHO grade 2, initial therapy may be deferred until radiographic or symptomatic progression in some people with positive prognostic factors (eg, complete resection, younger age) or concerns about short- and long-term toxicity given the natural history of the disease. |
| Astrocytoma, IDH-mutant, 1p19q non-codeleted, CNS WHO grade 3 (former anaplastic astrocytoma) | 1.6. People with astrocytoma, IDH-mutant, 1p19q non-codeleted CNS WHO grade 3 should be offered radiation therapy with adjuvant temozolomide. | 1.6. People with astrocytoma, IDH-mutant, 1p19q non-codeleted CNS WHO grade 3 should be offered RT with adjuvant TMZ. |
| Astrocytoma, IDH-mutant, CNS WHO grade 4 (former IDH-mutant glioblastoma) | 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.). | 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 (formerly anaplastic astrocytoma; see Recommendation 1.6) or like a glioblastoma, IDH-wildtype, CNS WHO grade 4 (formerly IDH-wildtype glioblastoma; see Recommendation 2.2) |
Key Takeaways:
- Recommendations 1.2.1 and 1.5.1 are new guideline updates, added in the 2025 update.
- Recommendations 1.2 and 1.5 received updated, clarified wording regarding the deferral of radiation therapy and chemotherapy.
- Recommendations 2.1 through 2.9 remain unchanged with this guideline update.
Read the full recommendation update on the official American Society of Clinical Oncology website.
While the FDA approval, and the INDIGO trial that the approval is based on, included patients as young as 12, the ASCO-SNO guideline update should only be considered for adult patients.
To learn more about the ASCO Guidelines for Therapy for Diffuse Astrocytic and Oligodendroglial Tumors in Adults, view our guidelines summary, pocket guide, patient summary, and quiz.
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