This protocol addresses adult patients (age 18 years or older) with pilocytic astrocytoma in whom a prior surgical or radiotherapy-based treatment has not achieved adequate local tumor control.
The previous approach included surgery (re-resection in selected patients) and/or radiotherapy — either conformal radiotherapy or stereotactic radiosurgery — for inoperable, recurrent, or residual/progressive tumors.
This approach did not achieve the stated goal of improved local tumor control (no local tumor progression on imaging). This protocol defines the next step following that failure.
Once surgery and radiotherapy have failed to control the tumor, systemic therapy becomes the focus. Depending on the patient's individual profile, this may involve chemotherapy or, in certain molecularly defined cases, targeted therapy — with the specific agents, selection criteria, and sequencing detailed in the full protocol.
The clinical goals of this protocol are radiographic tumor response (reduction in tumor size) and control of peritumoral edema.
DOI: 10.1093/neuonc/noac188
The most common drug that has been employed in adult patients is temozolomide, given the drug's benefit in diffuse gliomas as well as its good CNS penetration, and also other chemotherapy agents, such as carboplatin, etoposide, cyclophosphamide.
Consider targeted therapy with BRAF and/or MEK inhibitors in PAs, PXA, and gangliogliomas when BRAF altered.
Bevacizumab, a monoclonal antibody targeting the VEGF-A ligand, may be utilized in the setting of salvage therapy for the control of edema and symptomatic benefit.
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