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Advances in the management of patients with IDH-mutant glioma

J. Rossi,A. Picca,O. Santonocito,Silvia Schembari,Lorenzo Testaverde,M. Sanson,G. Berzero,A. D. Di Stefano

Published 2025 in The Oncologist

ABSTRACT

Abstract Background Isocitrate dehydrogenase (IDH)-mutant gliomas represent a distinct category of diffuse gliomas with unique biological behavior and clinical course. Over the past decade, our understanding of these tumors has dramatically evolved, thanks to advances in molecular classification, imaging, and targeted therapies. Method This review provides a comprehensive overview of the current landscape in IDH-mutant glioma management. Results We highlight key molecular features and recent refinements in WHO tumor classification, along with novel diagnostic tools such as magnetic resonance spectroscopy and liquid biopsy. Surgical strategies have also shifted, with emphasis on maximal safe resection guided by functional mapping and advanced neuroimaging. Therapeutically, IDH inhibitors like vorasidenib are emerging as promising agents in selected patient populations, offering prolonged disease control. Additionally, radiotherapy and chemotherapy remain critical components, with ongoing trials evaluating their integration with targeted approaches. Finally, we explore future directions, including immunotherapy, PARP inhibitors, and CDK4/6 inhibitors especially in recurrent or treatment-resistant cases. Conclusions This review underscores the importance of a multidisciplinary, precision medicine approach in optimizing outcomes for patients with IDH-mutant gliomas.

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