Characterization of contemporary practice patterns in the management of <i>IDH</i> -mutant glioma: A multidisciplinary multi-institutional survey.

Abstract

2058 Background: The management of isocitrate dehydrogenase (IDH) mutant glioma is rapidly evolving following the recent FDA approval of the mutant IDH inhibitor, vorasidenib. Optimal treatment decisions for many specific clinical scenarios remain undefined leading different neuro-oncology providers to recommend different treatment approaches. The aim of this study was to characterize how clinicians collectively approach different clinical scenarios and evaluate how demographic and professional backgrounds influence decision-making in IDH-mutant glioma. Methods: An online survey was developed by a team of neuro-oncologists and radiation oncologists and distributed via email and X to clinicians treating patients IDH-mutant glioma. The survey included demographic questions and multiple case-based clinical scenarios with standardized response options. We compared the responses of neuro/medical oncologists, radiation oncologists, and neurosurgeons, and performed univariable regression to identify predictors of treatment preference, as well as to understand familiarity and enthusiasm with the use of IDH inhibitors. Results: A total of 153 clinicians (58% neuro/medical-oncologists, 34% radiation oncologists, 8% neurosurgeons) completed the online survey. Five of ten scenarios reached consensus (&gt;75% agreement on a treatment option), while the remainder demonstrated heterogeneity of treatment approaches. Compared to neuro/medical oncologists, radiation oncologists were less likely than neuro/medical oncologists to recommend IDH inhibitor therapy (IRR 0.57, p&lt;0.001) and more likely to recommend radiotherapy (IRR 1.54, p&lt;0.001) or chemo-radiotherapy (IRR 1.47, p&lt;0.001). Neuro-oncologists and neurosurgeons reported the most and least familiarity, respectively, with the use of IDH inhibitors whereas medical oncologists and radiation oncologists reported the most and least enthusiasm for IDH inhibitor use, respectively. Conclusions: Our survey results evidence substantial variation in real-world management of IDH-mutant glioma across specialties and institutions. While several clinical scenarios demonstrated strong therapeutic consensus, others revealed diverse approaches, underscoring the need for ongoing multidisciplinary collaboration and further advancement of evidence-based consensus to guide clinical decisions.