OnCo

Glioma & glioblastoma: lines of therapy

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9 standard-of-care settings across 4 lines and 3 biomarker subgroups. Rows come from the cancer page's standard of care; the grid places each on its line and subgroup.

LineAll comersAge groupIDH
Screening, prevention and diagnosis1··
Advanced, first line1··
Second line1··
Other settings312

Screening, prevention and diagnosis

SubgroupSettingApproachProducts and trialsEvidence
All comersDiagnosisMRI with contrast; maximal safe resection with 5-ALA and intraoperative mapping; integrated histo-molecular diagnosis with methylation classification where available.64

Advanced, first line

SubgroupSettingApproachProducts and trialsEvidence
All comersGlioblastoma, newly diagnosedRadiotherapy 60 Gy (hypofractionated in elderly) with concurrent and 6 cycles adjuvant temozolomide; TTFields with maintenance temozolomide; trials for MGMT-unmethylated patients.94

Second line

SubgroupSettingApproachProducts and trialsEvidence
All comersGlioblastoma, recurrentRe-resection or LITT if feasible; lomustine; bevacizumab for oedema/steroid sparing; re-irradiation; clinical trial (CAR-T, FUS-BBB, vaccines) strongly preferred.66

Other settings

SubgroupSettingApproachProducts and trialsEvidence
All comersGlioblastomaResection → RT + temozolomideTTFields; lomustine/bevacizumab at relapse.91
All comersOligodendroglioma grade 3 / astrocytoma grade 3Radiotherapy plus PCV (RTOG 9402, EORTC 26951) or temozolomide (CATNON).91
All comersH3 K27M diffuse midline gliomaRadiotherapy; dordaviprone at progression (2025); GD2 CAR-T and ONC201 first-line trials.39
Age groupPaediatric low-grade gliomaResection where safe; chemotherapy (carboplatin/vincristine) or tovorafenib / dabrafenib-trametinib for BRAF-altered relapsed disease; avoid radiation in young children.43
IDHIDH-mutant grade 2Resection → vorasidenib or observation; RT/PCV for high-risk.74
IDHIDH-mutant grade 2 gliomaMaximal resection; vorasidenib for residual/recurrent disease (INDIGO); radiotherapy plus PCV or temozolomide for high-risk or progressive disease.77

Regimens in the library

Lines and subgroups are parsed from the setting text of each standard-of-care row and can misclassify an unusual phrasing; the row’s own setting is always shown. Guideline chips reflect the NCCN category and ESMO-MCBS grade recorded on the cancer page, checked on its stated date. Not medical advice.