Therapy for Diffuse Astrocytic and Oligodendroglial Tumors in Adults: ASCO-SNO Guideline.

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.
Competing Interests: Reprint Requests: 2318 Mill Road, Suite 800, Alexandria, VA 22314; guidelines@asco.org. Nimish A. MohileResearch Funding: Vascular Biogenics, Boston Biomedical, Quell, Tocagen Na Tosha GatsonHonoraria: NovocureConsulting or Advisory Role: NovocureTravel, Accommodations, Expenses: Novocure Andreas F. HottingerConsulting or Advisory Role: Ideogen (Inst), Bayer Roche (Inst), Novocure (Inst)Research Funding: Novocure (Inst)Travel, Accommodations, Expenses: Celgene, Novocure, Bristol Myers Squibb, Karyopharm Therapeutics Andrew LassmanHonoraria: Abbott MolecularConsulting or Advisory Role: Karyopharm Therapeutics, Sapience Therapeutics, QED Therapeutics, FORMA Therapeutics, Bayer, Orbus Therapeutics, BioClinica, Novocure, Elsevier, Vivacitas OncologyResearch Funding: AbbVie (Inst), Novartis (Inst), Genentech/Roche (Inst), Aeterna Zentaris (Inst), Celldex (Inst), Kadmon (Inst), BeiGene (Inst), VBI Vaccines (Inst), Pfizer (Inst), Millennium (Inst), Oncoceutics (Inst), Karyopharm Therapeutics (Inst), Bayer (Inst), QED Therapeutics (Inst), Agios (Inst), Orbus Therapeutics (Inst), BMS (Inst), RTOG Foundation (Inst)Patents, Royalties, Other Intellectual Property: ElsevierTravel, Accommodations, Expenses: AbbVie, BioClinica, Abbott Molecular, FORMA Therapeutics, Karyopharm Therapeutics, QED Therapeutics, Bayer, Novartis, Pfizer, VBI Vaccines Douglas NeyConsulting or Advisory Role: DNAtrixResearch Funding: Orbus Therapeutics, Denovo Biopharma (Inst) Phioanh Leia NghiemphuConsulting or Advisory Role: AbbVieResearch Funding: Novartis Adriana OlarConsulting or Advisory Role: Guardant Health, Anuncia Inc Jeffery OlsonConsulting or Advisory Role: American Cancer Society David SchiffConsulting or Advisory Role: Orbus Therapeutics, GlaxoSmithKline, PRAResearch Funding: Bayer (Inst) Helen A. ShihHonoraria: UpToDate Roy StrowdConsulting or Advisory Role: Monteris Medical, NovocureResearch Funding: Southeastern Brain Tumor Foundation, Jazz Pharmaceuticals, NIH, American Board of Psychiatry and Neurology, Alpha Omega AlphaOther Relationship: American Academy of Neurology (AAN) Martin van den BentThis author is a member of the Journal of Clinical Oncology Editorial Board. Journal policy recused the author from having any role in the peer review of this manuscript.Employment: AstraZeneca (I)Consulting or Advisory Role: AbbVie, Bristol Myers Squibb, Celgene, Agios, Boehringer Ingelheim, Bayer, Carthera, Genenta Science, Nerviano Medical Sciences, Boston PharmaceuticalsResearch Funding: AbbVie (Inst) Mateo ZiuStock and Other Ownership Interests: Gilead Sciences Jaishri BlakeleyConsulting or Advisory Role: AbbVie, AstraZeneca, Astellas Pharma, Exelixis, VertexResearch Funding: GlaxoSmithKline (Inst), Lilly (Inst), Sanofi (Inst), Bristol Myers Squibb (Inst)Travel, Accommodations, Expenses: ExelixisUncompensated Relationships: SpringWorks Therapeutics (Inst)Open Payments Link: https://openpaymentsdata.cms.gov/physician/747718No other potential conflicts of interest were reported.