Management of Adult Patients With Isocitrate Dehydrogenase-Mutant Gliomas in Australia: An Expert Position Statement From the Cooperative Trials Group for Neuro-Oncology.

Isocitrate dehydrogenase (IDH)-mutant low-grade and high-grade gliomas are primary brain cancers with slower growth rates and longer survival than IDH-wildtype counterparts. However, these tumors are fatal and because of the younger age of patients, result in significant morbidity and loss of productivity. Several management options are available at initial diagnosis for IDH-mutant gliomas (including close surveillance, surgery, radiation therapy, chemotherapy and/or targeted therapies either alone or in combination), however, there is limited data about optimal timing and sequencing. When considering treatment, the risks associated with uncontrolled disease should be weighed against potential treatment-associated toxicities given the expected long overall survival times for many patients. Preservation of cognition, neurological function and quality of life remain a priority. Treatment decisions should therefore be made in the context of a neuro-oncology multidisciplinary team, and incorporating the patient's wishes and expectations. The management of recurrent IDH-mutant glioma is not well defined. This expert position statement aims to provide an Australian perspective on the evidence base and available treatments for contemporaneous management of IDH-mutant glioma in adults.