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An Analysis for IDH-Mutant Grade 4 Astrocytoma Based on WHO CNS 5: Implication of Clinical Practice
Xianxin Qiu1, Liping Liang1, Lingchao Chen2
1Department of Radiation Oncology, Huashan Hospital, Fudan University, Shanghai, China.
Purpose:
There is ongoing debate regarding the therapeutic approach and prognosis for IDH-mutant grade 4 astrocytoma, a newly defined subtype of diffuse glioma in the 2021 WHO classification system for central nervous system tumors (WHO CNS 5). The aim of this study was to explore the clinical outcome and prognosticators for newly diagnosed IDH-mutant grade 4 astrocytoma based on our single institutional data.
Methods:
This retrospective analysis included 53 consecutive patients with newly diagnosed IDH-mutant grade 4 astrocytoma, who underwent radiotherapy between September 2021 and December 2023. All patients were administered concurrent and adjuvant temozolomide. Eleven patients received adjuvant tumor-treating fields (TTFields).
Results:
The median follow-up was 15.7 months. Twenty patients had tumor relapse; three patients died, all of whom were without TTFields therapy. The median PFS for the entire cohort was 19.3 months, and the median OS was not reached. Univariate analysis indicated patients younger than 40 years (p = 0.11) or without homozygous deletion of CDKN2A/B (p = 0.11) tended to have better PFS. In addition, the TTFields group tended to have longer median PFS than the non-TTFields group in both analyses before and after propensity score matching (PSM) (24.4 vs. 18.5 months, p = 0.097, before PSM; 24.4 vs. 15.9 months, p = 0.080, after PSM). No significant independent prognostic factor was found in the multivariate analysis.
Conclusions:
The study reveals important insights into clinical practice for IDH-mutant grade 4 astrocytoma. Younger age and tumor without deleted CDKN2A/B might be predictive of better outcomes. The addition of TTFields trended towards improved PFS, necessitating prospective clinical trials for further investigation.
Insights
Newly diagnosed IDH-mutant grade 4 astrocytoma patients showed improved progression-free survival (PFS) with tumor-treating fields (TTFields). Younger age and absence of CDKN2A/B deletion may predict better outcomes for this glioma subtype.
Area of Science:
- Neuro-oncology
- Central Nervous System Tumors
- Molecular Diagnostics
Background:
- IDH-mutant grade 4 astrocytoma is a newly defined entity in the WHO CNS 5 classification.
- Therapeutic strategies and prognosis for this glioma subtype are under active investigation.
- Understanding clinical outcomes is crucial for optimizing patient management.
Purpose of the Study:
- To investigate the clinical outcomes and prognostic factors for newly diagnosed IDH-mutant grade 4 astrocytoma.
- To analyze the impact of treatment modalities, including tumor-treating fields (TTFields), on patient prognosis.
- To identify potential predictive markers for improved survival in this patient cohort.
Main Methods:
- Retrospective analysis of 53 patients with newly diagnosed IDH-mutant grade 4 astrocytoma.
- Patients received radiotherapy with concurrent and adjuvant temozolomide.
- Eleven patients were treated with adjuvant tumor-treating fields (TTFields); propensity score matching was employed.
Main Results:
- Median follow-up was 15.7 months; 20 patients experienced tumor relapse.
- Median progression-free survival (PFS) was 19.3 months for the cohort.
- TTFields group showed a trend towards longer PFS compared to the non-TTFields group (24.4 vs. 18.5 months pre-PSM, p=0.097).
- Younger age (<40 years) and absence of homozygous CDKN2A/B deletion showed a trend towards better PFS (p=0.11).
Conclusions:
- Younger age and tumors without CDKN2A/B deletion may predict better outcomes in IDH-mutant grade 4 astrocytoma.
- The addition of TTFields showed a trend towards improved PFS, warranting further investigation.
- Prospective clinical trials are needed to validate these findings and establish optimal treatment paradigms.
