Treatment of Anaplastic Astrocytoma (IDH-Wildtype) in Adults

Clinical Scenario

IDH Mutation Absent · Adult Population

This protocol applies to adults with anaplastic astrocytoma, CNS WHO grade 3, in whom molecular testing confirms the absence of an IDH mutation (IDH-wildtype). This molecular finding is a key determinant of the treatment approach for this population.

Treatment Approach

First-line management is built around concurrent chemoradiation followed by adjuvant chemotherapy, with an additional therapy modality that may be considered in eligible patients after completing chemoradiation.

Full protocol details — all components, sequencing, eligibility criteria — are available via the structured regimen below.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1093/neuonc/noab279

People with astrocytomas, IDH-wildtype, CNS WHO grade 2 or 3 may be treated according to recommendations for glioblastoma, IDH-wildtype, CNS WHO grade 4 found in this guideline (Type: informal consensus; Evidence quality: very low; Strength of recommendation: weak).

Concurrent TMZ and RT should be offered to people with newly diagnosed glioblastoma, IDH-wildtype, CNS WHO grade 4 (Type: evidence-based, benefits outweigh harms; Evidence quality: moderate; Strength of recommendation: strong).

Six months of adjuvant TMZ should be offered to people with newly diagnosed glioblastoma, IDH-wildtype, CNS WHO grade 4 who have received concurrent RT plus TMZ (Type: evidence-based, benefits outweigh harms; Evidence quality: moderate; Strength of recommendation: strong).

Alternating electric field therapy may be added to adjuvant TMZ in people with newly diagnosed supratentorial glioblastoma, IDH-wildtype, CNS WHO grade 4 who have completed chemoradiation therapy (Type: evidence-based, benefits outweigh harms; Evidence quality: moderate; Strength of recommendation: weak).

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