Early Intervention and Post-Resection Decision-Making in IDH-Mutant Glioma

The approval of vorasidenib has introduced new questions surrounding optimal treatment timing in patients with lower-grade IDH-mutant glioma, particularly following surgical resection. While active surveillance has historically been a common approach after initial surgery, targeted IDH inhibition now offers clinicians an opportunity to intervene earlier in the disease course with the goal of delaying progression and postponing radiation or chemotherapy.

In this Special Report, Ugur T. Sener, MD, consultant in the Section of Neuro-Oncology and chair of the Division of Neuro-Oncology at Mayo Clinic, discusses how INDIGO trial findings are being incorporated into real-world clinical decision-making. The conversation explores the nuances of applying trial data to patients with varying extents of resection and how clinicians are navigating treatment discussions in the setting of newly approved targeted therapy.

In this final episode, Sener reviews evolving approaches to post-resection management in IDH-mutant glioma, including the growing role of earlier intervention with vorasidenib following subtotal resection. He also discusses ongoing considerations involving fertility, long-term toxicities, liver monitoring, and the need for continued follow-up data to better define optimal treatment sequencing and duration.