Management of Adult Patients With Isocitrate Dehydrogenase-Mutant Gliomas in Australia: An Expert Position Statement From the Cooperative Trials Group for Neuro-Oncology.

This expert position statement reviews current evidence and offers practical guidance for the contemporary management of IDH‑mutant diffuse gliomas in adults from an Australian neuro-oncology perspective.

Key points:

• IDH‑mutant low‑ and high‑grade gliomas grow more slowly and are associated with longer survival than IDH‑wildtype tumors, but remain ultimately fatal and carry substantial long‑term morbidity and socioeconomic impact due to the typically younger patient population.
• Multiple options exist at initial diagnosis—active surveillance, maximal safe resection, radiotherapy, chemotherapy, and emerging targeted therapies, alone or in combination—but high‑quality data to define the optimal timing, sequence, and combination of these approaches are limited.
• Because patients often live many years, decisions must carefully balance risks of undertreating the disease (progression, malignant transformation, neurologic decline) against both acute and late toxicities of treatment.
• Preservation of cognition, neurologic function, and overall quality of life is emphasized as a central goal, not just prolongation of survival.
• Treatment planning is recommended within a specialized neuro‑oncology multidisciplinary team and should explicitly incorporate patient preferences, values, and life goals.
• Management of recurrent IDH‑mutant glioma is particularly ill‑defined; the document summarizes the available evidence and expert opinion to guide therapy selection at relapse, acknowledging the current gaps and need for further research.