Brain gliomas, what they are and how to tackle them with precision oncology

Gliomas are the most common tumours of the central nervous system in adults. Every year there are more than 3,000 new cases in Italy. But they are not all the same. Among these neoplasms, low-grade gliomas with mutations in the Idh genes are rarer, representing true orphan diseases. But science is advancing. And it offers increasingly significant prospects even for the most complex cases. It is essential to know the pathologies and the possibilities of approach, in a field where knowledge is still very fragmented. To fill these gaps, the Aiom Foundation (Italian Association of Medical Oncology) launched a national online training and information campaign in recent months, as part of a project implemented with the unconditional contribution of the Servier Group in Italy.

I gliomi di basso grado rappresentano una realtà clinica complicata. La diagnosi arriva spesso improvvisamente, talvolta in pronto soccorso a seguito di crisi epilettiche, con un impatto pesantissimo sulla vita dei pazienti, prevalentemente giovani adulti tra i 20 e i 40 anni, e delle loro famiglie. «Questi tumori spesso vengono diagnosticati in età giovanile – sottolinea Saverio Cinieri, Presidente di Fondazione Aiom -. Si sviluppano da cellule del cervello chiamate gliali e possono avere una prognosi variabile ma potenzialmente a lungo termine. La gestione della patologia richiede una stretta collaborazione fra neurochirurgo, radioterapista e oncologo medico. Attraverso il bisturi è possibile rescindere la massa tumorale oppure eseguire una biopsia grazie a nuove e sofisticate tecnologie. La radioterapia permette di ridurre il rischio di recidiva o eliminare quella parte di cancro che non è stato possibile rimuovere chirurgicamente. Viene somministrata insieme alla chemioterapia e le sedute sono di s

'Even for the treatment of gliomas, in particular low-grade gliomas, precision oncology can be used, which may reshape clinical practice in the near future,' points out Enrico Franceschi, director of Nervous System Oncology at the Irccs Istituto delle Scienze neurologiche in Bologna. 'It is very important to check for the presence or absence of Idh1 and Idh2 mutations.

Why is it important to recognise these cellular characteristics? Because biomarkers indicate specific pathologies characterised by a decidedly more favourable prognosis and greater sensitivity of gliomas to radio and chemotherapy. In short, they allow therapy to be personalised as much as possible. 'At the time of diagnosis it is therefore essential to carry out some molecular tests early on in order to best identify the different subtypes of gliomas,' Franceschi recalls. 'Among the new generation therapies is also vorasidenib, an oral Idh1 and Idh2 inhibitor drug that has proven to be an effective treatment in postponing radio and chemotherapy in low-grade gliomas and is a significant medical-scientific innovation.

"Once again, medical oncology is central in the multidisciplinary management of extremely complex and insidious neoplasms,' Franceschi concludes. 'The treatment of gliomas begins at the moment of diagnosis, which must be both morphological and molecular. There are, in fact, 150 different subtypes of brain neoplasia, and it is essential to recognise the characteristics of the individual case from the outset in order to be able to select the most appropriate therapies. Until a few years ago, we only had surgery, radiotherapy and chemotherapy available. Now, targeted drugs are also a reality in the treatment of brain tumours that express specific molecular alterations.