PURPOSE: IDH-mutant glioma management has been rapidly evolving following the 2024 FDA approval of the mutant IDH inhibitor (IDHi), vorasidenib. However, optimal treatment decisions for many specific scenarios remain unclear. The aim of this study was to provide insight into how clinicians collectively approach different clinical scenarios and evaluate how demographic and professional backgrounds influence decision-making for IDH-mutant glioma. METHODS: A survey was developed by a team of neuro-oncologists and radiation oncologists and distributed via email and X (formerly Twitter) to clinicians who treat patients with IDH-mutant glioma (neuro/medical oncologists, radiation oncologists, and neurosurgeons). The survey included demographic questions and 10-13 case-based clinical scenarios with standardized response options. We compared responses between neuro/medical oncologists and radiation oncologists and performed univariable regression to identify predictors of treatment preference and IDHi familiarity/enthusiasm. RESULTS: A total of 153 clinicians (58% neuro/medical-oncologists, 34% radiation oncologists, 8% neurosurgeons) completed the survey. Five of ten scenarios reached consensus (> 75% agreement on a treatment option), while the remainder demonstrated heterogeneity. Compared to neuro/medical oncologists, radiation oncologists were less likely to recommend IDHi (IRR 0.57, p < 0.001) and more likely to recommend radiotherapy (IRR 1.54, p < 0.001) or chemoradiotherapy (IRR 1.47, p < 0.001). Neuro-oncologists and neurosurgeons reported the most and least familiarity with IDHi, respectively, whereas medical oncologists and radiation oncologists reported the most and least enthusiasm for IDHi, respectively. CONCLUSIONS: Substantial variation exists in real-world management of IDH-mutant glioma across specialties and institutions. While several clinical scenarios demonstrated strong consensus, others revealed uncertainty, underscoring the need for ongoing multidisciplinary collaboration and further advances in evidence-based consensus to guide clinical decisions.
Lanman et al. (Mon,) studied this question.