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OpenOnco · DIS-GLIOMA-LOW-GRADE · BIO-IDH-MUTATION (ESCAT IA)
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Treatment plan — DIS-GLIOMA-LOW-GRADE
PLAN-BMA-IDH_MUTATION_GLIOMA_LOW_GRAD-V1 · v1 · 2026-05-04
Patient
BMA-IDH_MUTATION_GLIOMA_LOW_GRAD · Algorithm: ALGO-GLIOMA-LGG-1L

Clinical significance of mutations (ESCAT)

Tumor-board context — the engine does not use these tiers to rank tracks
BiomarkerVariantESCATEvidenceClinical significanceDrugsSources
BIO-IDH-MUTATIONIDH1 or IDH2 mutation (IDH1 R132H most common >90%; IDH1 R132C/G/S/L; IDH2 R140Q/R172K — WHO CNS grade 2 astrocytoma or oligodendroglioma context)IA
  • SRC-EANO-LGG-2024: Level A (Supports, Sensitivity/Response)
  • SRC-NCCN-CNS-2025: Level Category 1 (Supports, Sensitivity/Response)
IDH1/IDH2 mutation is the defining molecular feature of WHO grade 2 (and 3) diffuse gliomas — astrocytoma, IDH-mutant and oligodendroglioma, IDH-mutant and 1p/19q codeleted. Vorasidenib (dual IDH1/IDH2 inhibitor) is FDA-approved (Aug 2024) for IDH1- or IDH2-mutated grade 2 glioma in adults following prior surgery. INDIGO trial (Mellinghoff et al. NEJM 2023 — phase III, 331 pts): vorasidenib 40 mg/day vs placebo; mPFS 27.7 vs 11.1 mo (HR 0.39, p<0.001); 61% reduction in risk of progression or death; time to next intervention also significantly improved. The approval defines a new 1L systemic standard after surgery for IDH-mutant grade 2 glioma. EANO 2024 guidelines incorporate vorasidenib as preferred systemic option at progression or post-biopsy-only grade 2 IDH-mutant glioma. IDH1 R132H accounts for >90% of IDH-mutant LGG; IDH2 mutations ~3-5%; rare non-R132H IDH1 mutations ~5%.vorasidenib 40 mg PO once daily monotherapy (post-surgical 1L; INDIGO regimen)
  • SRC-EANO-LGG-2024
  • SRC-NCCN-CNS-2025

Treatment options (1 tracks)

Aggressive plan
★ DEFAULT
Indication
IND-GLIOMA-LOW-GRADE-1L-RT-PCV
Regimen
—
Reason
Engine default per algorithm ALGO-GLIOMA-LGG-1L: {'step': 3, 'outcome': False, 'branch': {'result': 'IND-GLIOMA-LOW-GRADE-1L-RT-PCV'}, 'fired_red_flags': [], 'winner_red_flag': None}

What NOT to do

Explicit prohibitive rules, each grounded in a regimen / supportive care / contraindication entity
Aggressive plan (IND-GLIOMA-LOW-GRADE-1L-RT-PCV)
  • Do not skip molecular profiling (IDH1/2, 1p/19q, ATRX, MGMT, CDKN2A) — defines grade per WHO 5th ed. and choice of adjuvant
  • Do not prescribe RT+PCV to patients with IDH-wildtype LGG — reclassify to GBM, requires Stupp protocol
  • Do not start PCV without baseline LFTs, CBC + contraception (procarbazine teratogen + EtOH-disulfiram-like reaction)
  • Do not skip levetiracetam-based AED in patients with seizures — does not induce P450, unlike phenytoin/carbamazepine

MDT brief

Skills (recommended) — for consideration (1)

  • Clinical pharmacist recommended
    Chemoimmunotherapy regimen — drug-drug interactions, dose adjustments, premedication.
    skill: clinical_pharmacistv0.1.0reviewed 2026-04-25STUBsign-offs: 0lead: TBD

Open questions (1, 0 blocking)

  • OQ-LDH-CURRENT
    What is the current LDH? Marker of tumor burden and transformation.
    LDH is part of the prognostic indices of indolent lymphomas.
    → hematologist

Data quality

  • Unevaluated RedFlags: RF-GLIOMA-LOW-GRADE-FRAILTY-AGE, RF-GLIOMA-LOW-GRADE-HIGH-RISK-BIOLOGY, RF-GLIOMA-LOW-GRADE-INFECTION-SCREENING, RF-GLIOMA-LOW-GRADE-INTRACRANIAL-PRESSURE, RF-GLIOMA-LOW-GRADE-ORGAN-DYSFUNCTION, RF-GLIOMA-LOW-GRADE-TRANSFORMATION-PROGRESSION

Skill catalog (1/16 activated in this plan)

All registered virtual specialists. ✓ — activated for this case; ○ — not activated (available for other clinical scenarios).
Specialistskill_idVersionLast reviewedSign-offsDomain
Cellular therapy specialist (CAR-T)cellular_therapy_specialistv0.1.02026-04-250cellular_therapy
Clinical pharmacistclinical_pharmacistv0.1.02026-04-250clinical_pharmacy
Hematologist / oncohematologisthematologistv0.1.02026-04-250hematology_oncology
Hematopathologist (lymphoma / leukemia / myeloma)hematopathologistv0.1.02026-04-250hematopathology
Infectious disease / hepatologyinfectious_disease_hepatologyv0.1.02026-04-250infectious_diseases
Medical oncologist (solid-tumor chemotherapist)medical_oncologistv0.1.02026-04-250solid_oncology
Molecular geneticist / molecular oncologistmolecular_geneticistv0.1.02026-04-250molecular_oncology
Palliative carepalliative_carev0.1.02026-04-250palliative_care
Pathologist (general)pathologistv0.1.02026-04-250pathology
Primary care / family physicianprimary_carev0.1.02026-04-250primary_care
Psycho-oncologistpsychologistv0.1.02026-04-250psychosocial
Radiation oncologistradiation_oncologistv0.1.02026-04-250radiation_oncology
Radiologistradiologistv0.1.02026-04-250diagnostic_imaging
Social worker / case managersocial_worker_case_managerv0.1.02026-04-250psychosocial
Surgical oncologistsurgical_oncologistv0.1.02026-04-250surgical_oncology
Transplant specialist (BMT)transplant_specialistv0.1.02026-04-250cellular_therapy

Sources cited

Experimental options (clinical trials)

Last synced: 2026-05-04 · ctgov.

No active trials matched this scenario in ctgov.

Option availability in Ukraine

Per-track UA registration · NSZU · cost · access pathway. Render-time metadata; engine selection does not depend on these fields (CHARTER §8.3).
OptionUA registrationNSZUCost orientationAccess pathway
Aggressive plan
—
No regimen components on this track — availability unknown
— unknown— unknown₴-? — verify pathwaynot recorded

Cost information is orientation. Verify with a specific pharmacy / foundation / trial site. Status updated: 2026-05-04.

plan_id: PLAN-BMA-IDH_MUTATION_GLIOMA_LOW_GRAD-V1 | version: 1 | generated: 2026-05-04T14:13:16.602943+00:00
Per FDA non-device CDS positioning (CHARTER §15): Outpatient oncology treatment planning to support tumor-board discussion. Not a medical device; not for autonomous clinical decision-making.
Per FDA non-device CDS positioning (CHARTER §15): Both treatment options below are presented for review. The engine's selection of a 'recommended' default does not constitute a clinical decision. Final treatment selection requires HCP judgment incorporating information not available to the system.
This document is an informational resource supporting tumor-board discussion (per CHARTER §11). It is not a system that makes clinical decisions. Every recommendation must be verified by the treating physician.