Clinical guidelines for adult diffuse gliomas

Professor Jiang Tao, Institute of Neurosurgery, Beijing Capital Medical University, etc., updated the clinical practice guidelines for gliomas in China, the Chinese Glioma Cooperative Organization (CGCG), the China Neuro-China Society (SNO-China) and the Chinese Brain Cancer Association (CBCA) in line with the latest advances in the revision of the WHO Fourth Edition Central Nervous System Tumor Classification Standards and the combination of diffuse glioma treatment. The
guidelines focus on key treatments such as molecular and pathological diagnosis, surgery, radiotherapy, and chemotherapy, and integrate the results of clinical trials of immunotherapy and targeted therapies, and provide guidance to clinicians on the treatment of adult diffuse gliomas, including WHOII.-IV.grade adult ascytoblastomas, abrus glioblastomas and their variants, and discuss histology and molecular diagnosis and the latest treatment strategies and new therapies.
article was published online in November 2020.
the results of these studies, the diagnosis of gliomas is mainly based on microstructural similarity and differentiation levels with different hypothetical origin cells.
with the accumulation of genetic fundamentals on tumor development, molecular characteristics are found to contribute to the classification of gliomas.
the current recommended diagnosis of glioma is a combination of tissue credits and molecular characteristics.
the application of molecular characteristics has been recommended to clinical practice and provide more information on the biological behavior of tumors to improve patient prognostics.
treatment of glioma requires a multidisciplinary combination, including surgical excision, radiotherapy, chemotherapy and supportive treatment.
and apply the overall treatment algorithm.
newly diagnosed or relapsed gliomas should take into account factors such as the patient's age, clinical manifestations, imaging results, and tumor molecular characteristics (Table 1).
table 1. Recommendations for glioma treatment and the latest treatment options for evidence-based glioma include molecular targeted therapy, immunotherapy and IDH targeted therapy.
in molecular targeted therapy, the subject tyrosine kinase (RTK)-PI3K, TP53 and RB pathway mutations are more, can be used as a treatment.
genes such as RTKs have been the target of treatment in clinical trials of gliomas, but the therapeutic effect is not obvious.
using TKI, Merotin's research on EGFR targeted therapy is ongoing.
Phase II clinical trial showed that the treatment of reococctic EGFR amplification glioblastoma with co-steroneamine showed good results, but was found to be ineffective and terminated early in Phase III.
While targeted treatment has not significantly improved the survival of glioma patients, multi-model treatments combined with existing standard care and new therapies may help improve the survival and quality of life of glioma patients.
immunotherapy, including immunization, lysovirus, immuno checkpoint inhibitors, etc., is also the focus of GBM treatment research.
negative results of immunotherapy for malignant gliomas are disappointing, local immunosuppression in a combined therapy or reversal of micro-environments may be a promising treatment.
IDH1/2 gene mutations are more common in human gliomas.
IDH1 R132H in gliomas is an important result of biomedical research.
in a Phase I study, patients with advanced gliomas with IDH mutations used ivosidenib (AG-120) 500 mg once a day to prolong disease control and inhibit the growth of non-enhancing tumors.
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