Isocitrate dehydrogenase-mutant glioma in the post-INDIGO era: advances in classification and management

Purpose of review Recent advances have reshaped the classification and management of IDH-mutant glioma. Updated molecular diagnostic frameworks, evolving multidisciplinary treatment strategies, and the emergence of mutant IDH inhibitors have introduced new therapeutic opportunities while also raising important unresolved clinical questions. This review summarizes recent developments and ongoing controversies in the post-INDIGO era. Recent findings Recent cIMPACT-NOW recommendations further refine molecular classification and grading criteria for IDH-mutant glioma. Increasing evidence supports maximal safe resection and, in select cases, supramaximal resection, particularly in astrocytoma. Questions regarding the optimal timing and modality of radiation therapy remain unresolved. Comparative studies of chemotherapy regimens continue to demonstrate tradeoffs between efficacy and toxicity. The INDIGO trial established mutant IDH inhibition as a new treatment paradigm, and ongoing studies seek to optimize patient selection and explore new types of IDH-directed therapies. Summary Management of IDH-mutant glioma is becoming increasingly individualized and molecularly driven. Although mutant IDH inhibitors represent a major therapeutic advance, their integration with existing treatment paradigms remains uncertain. Ongoing studies will continue to refine prognostic stratification and multidisciplinary management strategies in this population.