Oligodendroglioma, IDH-mutant and 1p/19q-codeleted: the decisions you may face
4 treatment settings, 3 with more than one named option. Each section lays out the options the standard of care names, what each is for, the trials behind them with their recorded results, the side effects and cautions on record, and questions to ask. Built from the cancer page's standard-of-care rows; nothing here is advice for your case.
Newly diagnosed
Maximal safe resection and molecular diagnosis with 1p/19q testing; observation is reasonable after gross total resection of a grade 2 tumour in a younger patient.
Reading chemical tags on DNA that reveal a cell's identity, used to classify brain tumours and to detect cancer in blood.
- Cell-of-origin memory
- Stable analyte in blood
For low-risk prostate cancer, monitoring with PSA, MRI, and repeat biopsy instead of treating, because most such cancers never cause harm.
- Avoids incontinence and erectile dysfunction of treatment in men who would never be harmed
- Level-1 evidence of safety (ProtecT)
No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.
- Reference cohort dependence
- Anxiety and adherence
- Repeat biopsies
- Under-used outside high-income countries
- Between DNA methylation profiling and Active surveillance, which do you recommend for me, and what about my case would make you choose differently?Why: Guidelines list several reasonable options; the choice turns on details of your tumour, your health and your priorities.
- What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?Why: The aim shapes how much side effect and disruption is worth accepting.
- What happens if I delay, or decline this step for now? Is the decision reversible?Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
- Does your recommendation follow the current guideline (NCCN Guidelines: Central Nervous System Cancers), and if it departs from it, why?Why: Departures from guidelines are sometimes right for an individual; they should be explained.
- What is my exact diagnosis, stage, and grade, and which tests established them?Why: Everything else follows from an accurate stage and subtype.
- Which biomarkers have been tested on my tumour (for example IDH1 or IDH2 mutation, Whole-arm 1p/19q codeletion, TERT promoter mutation, CIC and FUBP1 mutations, CDKN2A/B homozygous deletion), and what were the results?Why: These results decide eligibility for targeted therapy, immunotherapy, and trials.
- Which subtype is my cancer, and does that change the recommended treatment?Why: Recognised subtypes for this cancer include Oligodendroglioma, IDH-mutant and 1p/19q-codeleted, grade 2, Oligodendroglioma, IDH-mutant and 1p/19q-codeleted, grade 3, Oligodendroglioma with minigemistocytes or gliofibrillary oligodendrocytes.
- Is germline (inherited) genetic testing recommended for me or my family?Why: Inherited variants can change treatment and matter for relatives.
- For my situation (newly diagnosed), which of the standard options do you recommend and why?Why: Guideline options include: Maximal safe resection and molecular diagnosis with 1p/19q testing; observation is reasonable after gross total resection of a grade 2 tumour in a younger patient.
Add these to your appointment list, or take the full question set for this cancer.
Grade 2, residual or recurrent, not needing radiotherapy
Vorasidenib (INDIGO) or continued observation.
The first targeted therapy for low-grade brain tumours, delaying the need for radiation and chemotherapy by years.
- Tests VorasidenibResidual or recurrent grade 2 IDH-mutant astrocytoma or oligodendroglioma after surgery, no prior RT/chemo: vorasidenib vs placebo
PFS 27.7 vs 11.1 months, HR 0.39.
Progression-free survival (BIRC) (months): Vorasidenib 27.7 (n=168) vs Placebo 11.1 (n=163) · HR 0.39 · source
No side-effect rates or interaction flags are recorded for these options yet. The side-effect lookup and interaction checker cover the products that have them.
- Is Vorasidenib the only reasonable path for me, or is there a trial, a different sequence or a wait-and-see option?Why: A single standard does not mean a single choice; timing and trials are decisions too.
- What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?Why: The aim shapes how much side effect and disruption is worth accepting.
- How closely do I match the people in INDIGO, and does that change what the results mean for me?Why: Trial populations are selected; age, fitness, prior treatment and biomarkers all affect how far results carry.
- What happens if I delay, or decline this step for now? Is the decision reversible?Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
- Does your recommendation follow the current guideline (NCCN Guidelines: Central Nervous System Cancers), and if it departs from it, why?Why: Departures from guidelines are sometimes right for an individual; they should be explained.
- For my situation (grade 2, residual or recurrent, not needing radiotherapy), which of the standard options do you recommend and why?Why: Guideline options include: Vorasidenib (INDIGO) or continued observation.
- Am I a candidate for Vorasidenib, and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
- How do the results of INDIGO apply to someone like me?Why: Trial populations differ from individual patients; ask how closely you match.
Add these to your appointment list, or take the full question set for this cancer.
Grade 2, high risk, and grade 3
Radiotherapy followed by PCV (procarbazine, lomustine, vincristine), the regimen validated in RTOG 9402, EORTC 26951 and RTOG 9802; radiotherapy with temozolomide is an alternative being compared in CODEL.
IMRT and IGRT shape the radiation beam to the tumour's outline from multiple angles and check the patient's position with a scan before every session, so surrounding organs receive less dose. Fewer, larger doses are now standard in breast and prostate cancer, but a low-dose bath still spreads across normal tissue.
- Conformal dose, fewer side effects
- Hypofractionation saves visits
Procarbazine (Matulane) is an old chemotherapy capsule from the MOPP regimen for Hodgkin lymphoma; it is now used mainly in the PCV combination for certain brain tumours.
An old chemotherapy pill used when glioblastoma comes back, and the control arm most new glioblastoma drugs must beat.
A plant-derived chemotherapy from the Madagascar periwinkle that has been in almost every childhood leukaemia and lymphoma regimen since the 1960s.
The only chemotherapy proven to extend life in glioblastoma, given during and after radiation. It works best when the tumour has switched off a repair gene called MGMT.
- Anaplastic oligodendroglioma and oligoastrocytoma: PCV chemotherapy before radiotherapy versus radiotherapy alone
Show survival figures (1)
Averages across everyone diagnosed, often years ago. Your stage, subtype, age, fitness and the treatment you receive matter more than the average, and the numbers are improving quickly.
- 1p/19q co-deleted: median overall survival 14.7 vs 7.3 years.
Median overall survival, 1p/19q co-deleted (years): PCV then radiotherapy 14.7 (n=59) vs Radiotherapy alone 7.3 (n=67) - Anaplastic oligodendroglial tumours: radiotherapy followed by six cycles of PCV chemotherapy versus radiotherapy alone
Show survival figures (1)
Averages across everyone diagnosed, often years ago. Your stage, subtype, age, fitness and the treatment you receive matter more than the average, and the numbers are improving quickly.
- Median overall survival 42.3 vs 30.6 months overall; in 1p/19q co-deleted tumours not reached vs 112 months.
Overall survival (months): Radiotherapy + adjuvant PCV 42.3 vs Radiotherapy alone 30.6 · HR 0.75 · source
- Low-dose bath to normal tissue
- Motion management
- Fatal if given intrathecally: label all syringes.
- Take on an empty stomach or at bedtime to reduce nausea; PJP prophylaxis during concurrent chemoradiation.
- Between IMRT / IGRT (modern external beam), Procarbazine, Lomustine (CCNU) and the other options, which do you recommend for me, and what about my case would make you choose differently?Why: Guidelines list several reasonable options; the choice turns on details of your tumour, your health and your priorities.
- What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?Why: The aim shapes how much side effect and disruption is worth accepting.
- How closely do I match the people in RTOG 9402 and EORTC 26951, and does that change what the results mean for me?Why: Trial populations are selected; age, fitness, prior treatment and biomarkers all affect how far results carry.
- What happens if I delay, or decline this step for now? Is the decision reversible?Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
- Does your recommendation follow the current guideline (NCCN Guidelines: Central Nervous System Cancers), and if it departs from it, why?Why: Departures from guidelines are sometimes right for an individual; they should be explained.
- For my situation (grade 2, high risk, and grade 3), which of the standard options do you recommend and why?Why: Guideline options include: Radiotherapy followed by PCV (procarbazine, lomustine, vincristine), the regimen validated in RTOG 9402, EORTC 26951 and RTOG 9802; radiotherapy with temozolomide is an alternative being compared in CODEL.
- Am I a candidate for Procarbazine, Lomustine (CCNU), Vincristine or related drugs, and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
- How do the results of RTOG 9402 and EORTC 26951 apply to someone like me?Why: Trial populations differ from individual patients; ask how closely you match.
Add these to your appointment list, or take the full question set for this cancer.
Recurrence
Re-resection, temozolomide or lomustine, re-irradiation; bevacizumab for symptoms.
The only chemotherapy proven to extend life in glioblastoma, given during and after radiation. It works best when the tumour has switched off a repair gene called MGMT.
An old chemotherapy pill used when glioblastoma comes back, and the control arm most new glioblastoma drugs must beat.
A blood-vessel-blocking antibody that shrinks glioblastoma on scans and reduces swelling, but has never been shown to help patients live longer.
No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.
- Take on an empty stomach or at bedtime to reduce nausea; PJP prophylaxis during concurrent chemoradiation.
- Between Temozolomide, Lomustine (CCNU) and Bevacizumab (glioblastoma use), which do you recommend for me, and what about my case would make you choose differently?Why: Guidelines list several reasonable options; the choice turns on details of your tumour, your health and your priorities.
- What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?Why: The aim shapes how much side effect and disruption is worth accepting.
- What happens if I delay, or decline this step for now? Is the decision reversible?Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
- For my situation (recurrence), which of the standard options do you recommend and why?Why: Guideline options include: Re-resection, temozolomide or lomustine, re-irradiation; bevacizumab for symptoms.
- Am I a candidate for Temozolomide, Lomustine (CCNU), Bevacizumab (glioblastoma use), and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
Add these to your appointment list, or take the full question set for this cancer.