Table 2.
Reasonable Doses and Schedules by Recommendation
| IDH-Mutant Glioma | |||
|---|---|---|---|
| Recommendation | Therapy | Dose and Schedule | Source |
| Recommendation 1.1 (IDH-mutant, 1p19q codeleted oligodendroglioma [grade 2]) and 1.4 (IDH-mutant, 1p19q non-codeleted diffuse astrocytoma [grade 2]) | Radiation | 54 Gy in 30 fractions over 6 weeks | As used in the RTOG 9802 trial63 |
| Adjuvant PCV | Procarbazine 60 mg/m2 orally once per day days 8 through 21, lomustine 110 mg/m2 orally once on day 1, and vincristine 1.4 mg/m2 IV once daily on days 8 and 29 in 8 week cycle for a total of six cycles | As used in the RTOG 9802 trial63 and As used in the EORTC 26951 trial56 | |
| Adjuvant TMZ | 150-200 mg/m2 adjuvant TMZ given once daily on days 1-5 every 4 weeks for a maximum of 12 months | As used in the CATNON trial53 | |
| Recommendation 1.3 (IDH-mutant, 1p19q codeleted, anaplastic oligodendroglioma [grade 3]) | Radiation | 59.4 Gy in 33 fractions at five fractions per week | As used in the EORTC 26951 trial56 |
| Adjuvant PCV | As in 1.1 and 1.4 | ||
| Adjuvant TMZ | As in 1.1 and 1.4 | ||
| Recommendation 1.6 (IDH-mutant, 1p19q non-codeleted anaplastic astrocytoma [grade 3]) | Radiation | 59.4 Gy given in 33 fractions of 1.8 Gy | As used in the CATNON trial53 |
| Adjuvant TMZ | As in 1.1 and 1.4 | As used in the CATNON trial53 | |
| IDH-Wildtype Glioma | |||
| Recommendation | Therapy | Dose and Schedule | Source |
| Recommendation 2.2 and 2.3 (newly diagnosed glioblastoma) | Radiation | 60 Gy in 2 Gy fractions 5 fractions a week | As used in the EORTC 26981-22981 trial16 |
| Concurrent TMZ | 75 mg/m2 daily TMZ during RT | As used in the EORTC 26981-22981 trial16 | |
| Adjuvant TMZ | 150-200 mg/m2 once daily for five out of 28 consecutive days for a maximum of 6 months | As used in the EORTC 26981-22981 trial16 | |
| Recommendation 2.4 (newly diagnosed supratentorial GBM who have completed chemoradiation therapy) | Alternating electric field therapy | Daily use, > 18 hours per day, until second progression | See EF-14 trial protocol14 for details on therapy |
| Recommendation 2.6 (patients where the expected survival benefits of a 6-week radiation course combined with TMZ may not outweigh the harms) | Hypofractionated radiation | 40.05 Gy in 15 fractions over 3 weeks | As used in Perry et al30 |
| Concurrent TMZ | 75 mg/m2 once daily for 21 days | As used in Perry et al30 | |
| Adjuvant TMZ | 150-200 mg/m2 once daily for five of 28 consecutive days for a maximum of 12 months | As used in Perry et al30 | |
| Recommendation 2.7 (patients with older age, poor performance status, or with concerns about toxicity or prognosis) | Hypofractionated radiation alone | 40 Gy in 15 fractions over 3 weeks | As used in Roa et al46 |
| TMZ alone | 100 mg/m2 once daily on days 1-7 of every 2 weeks until progression. OR 200 mg/m2 once daily on days 1-5 of every 28 days for up to six cycles |
As used in NOA-08 trial66 As used in Nordic trial26 |
NOTE. Only recommendations with recommended therapy are listed.
Abbreviations: GBM, glioblastoma; IDH, isocitrate dehydrogenase; IV, intravenous; PCV, procarbazine, lomustine, vincristine; RT, radiation therapy; TMZ, temozolomide.