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Prospective genomically guided identification of 'early/evolving' and 'undersampled' IDH-wildtype glioblastoma leads to improved clinical outcomes
- Source :
- Neuro-oncology, vol 24, iss 10
- Publication Year :
- 2022
-
Abstract
- Background Genomic profiling studies of diffuse gliomas have led to new improved classification schemes that better predict patient outcomes compared to conventional histomorphology alone. One example is the recognition that patients with IDH-wildtype diffuse astrocytic gliomas demonstrating lower-grade histologic features but genomic and/or epigenomic profile characteristic of glioblastoma typically have poor outcomes similar to patients with histologically diagnosed glioblastoma. Here we sought to determine the clinical impact of prospective genomic profiling for these IDH-wildtype diffuse astrocytic gliomas lacking high-grade histologic features but with molecular profile of glioblastoma. Methods Clinical management and outcomes were analyzed for 38 consecutive adult patients with IDH-wildtype diffuse astrocytic gliomas lacking necrosis or microvascular proliferation on histologic examination that were genomically profiled on a prospective clinical basis revealing criteria for an integrated diagnosis of “diffuse astrocytic glioma, IDH-wildtype, with molecular features of glioblastoma, WHO grade IV” per cIMPACT-NOW criteria. Results We identified that this diagnosis consists of two divergent clinical scenarios based on integration of radiologic, histologic, and genomic features that we term “early/evolving” and “undersampled” glioblastoma, IDH-wildtype. We found that prospective genomically guided identification of early/evolving and undersampled IDH-wildtype glioblastoma resulted in more aggressive patient management and improved clinical outcomes compared to a biologically matched historical control patient cohort receiving standard-of-care therapy based on histomorphologic diagnosis alone. Conclusions These results support routine use of genomic and/or epigenomic profiling to accurately classify glial neoplasms, as these assays not only improve diagnostic classification but critically lead to more appropriate patient management that can improve clinical outcomes.
- Subjects :
- Adult
Cancer Research
precision medicine
Oncology and Carcinogenesis
Astrocytoma
molecular neuro-oncology
molecular diagnostics
Rare Diseases
Clinical Research
Genetics
Humans
Oncology & Carcinogenesis
Prospective Studies
Cancer
screening and diagnosis
Brain Neoplasms
Human Genome
glioblastoma
Neurosciences
Glioma
Isocitrate Dehydrogenase
Brain Disorders
Brain Cancer
Detection
Oncology
Mutation
Neurology (clinical)
genomic profiling
Glioblastoma
Biotechnology
4.2 Evaluation of markers and technologies
Subjects
Details
- ISSN :
- 15235866
- Volume :
- 24
- Issue :
- 10
- Database :
- OpenAIRE
- Journal :
- Neuro-oncology
- Accession number :
- edsair.doi.dedup.....ebaa701d8cc0c6c8d5ee6cfe30727d53