Earlier Intervention in IDH-Mutant Glioma: Rethinking Treatment After Resection

The management of IDH-mutant diffuse glioma is increasingly moving beyond a reactive approach toward one focused on earlier intervention and long-term disease control. Although surgical resection remains a cornerstone of treatment, the persistence of microscopic disease and the risk of recurrence continue to challenge clinicians, particularly when balancing tumor control with preservation of neurologic function and quality of life.

At the 2026 AAN Annual Meeting in Chicago, Katherine B. Peters, MD, PhD, neuro-oncologist at Duke Health and professor of neurology and neurosurgery at the Preston Robert Tisch Brain Tumor Center, spoke with NeurologyLive® about the evolving role of targeted therapy following findings from the phase 3 INDIGO trial (NCT04164901). Peters discussed how the FDA approval of vorasidenib has broadened its use beyond the trial population and how these data are beginning to influence real-world decision-making, particularly in the post-surgical setting. She also emphasized the importance of multidisciplinary care, including collaboration between neuro-oncology, epilepsy specialists, and general neurology.

In this episode, Peters explores how clinicians should think about initiating therapy earlier in the disease course, even after gross total or supramaximal resection. She highlights the inevitability of tumor regrowth, the potential benefits of early intervention for both tumor and seizure control, and key unanswered questions related to treatment in higher-grade disease, fertility considerations, and long-term management strategies.