The first 60 days: Glioma & glioblastoma

Staging tests establish exactly what and where the cancer is. Everything else follows from the answers.

• Diagnosis

  MRI with contrast; maximal safe resection with 5-ALA and intraoperative mapping, with early postoperative MRI to measure the extent of resection; integrated histo-molecular diagnosis with methylation classification where available.

  MRIFluorescence-guided surgeryExtent of resection (RANO resect classes)DNA methylation profiling
• Glioblastoma, newly diagnosed

  Radiotherapy 60 Gy in 30 fractions with concurrent and 6 cycles adjuvant temozolomide; from age 65, short-course radiotherapy (40 Gy in 15 fractions) with temozolomide (CCTG CE.6); for older patients unfit for combined treatment, temozolomide alone or hypofractionated radiotherapy alone, chosen by MGMT status (Nordic, NOA-08); TTFields with maintenance temozolomide; trials for MGMT-unmethylated patients.

  EORTC 26981 / NCIC CE.3 (Stupp trial)CCTG CE.6 / EORTC 26062-22061 (Perry trial)TemozolomideEF-14Optune / Optune Pax (TTFields)IMRT / IGRT (modern external beam)MGMT promoter methylationNOA-08

These specialties appear in the standard of care for this cancer. In most centres they meet weekly as a tumour board to agree each plan; you can ask when yours was discussed and what was decided.

• PathologistNamed in the standard of care for: Diagnosis.
• RadiologistNamed in the standard of care for: Glioblastoma, Diagnosis.
• SurgeonNamed in the standard of care for: Glioblastoma, IDH-mutant grade 2, Diagnosis, Glioblastoma, recurrent and 2 more.
• Medical oncologistNamed in the standard of care for: Glioblastoma, IDH-mutant grade 2, Glioblastoma, newly diagnosed, Glioblastoma, recurrent and 4 more.
• Clinical oncologist (radiotherapy)Named in the standard of care for: Glioblastoma, Glioblastoma, newly diagnosed, Glioblastoma, recurrent, IDH-mutant grade 2 glioma and 3 more.
• Transplant and cell therapy teamNamed in the standard of care for: Glioblastoma, recurrent, H3 K27M diffuse midline glioma.

A second opinion from a centre that treats many similar cases is normal, not rude; the standard of care tells you what to compare it against.

Each row is a setting from the standard of care, in the order it usually arises. Not all will apply to you; your stage and biomarkers decide which do. The guideline grade, where recorded, says how strong the evidence is.

1. 1.GlioblastomaNCCN Guidelines: Central Nervous System Cancers

   Resection → RT + temozolomide → TTFields; lomustine/bevacizumab at relapse.

   Fluorescence-guided surgeryIMRT / IGRT (modern external beam)Optune / Optune Pax (TTFields)
2. 2.IDH-mutant grade 2NCCN Guidelines: Central Nervous System Cancers

   Resection → vorasidenib or observation; RT/PCV for high-risk.

   Vorasidenib
3. 3.Glioblastoma, recurrent

   Re-resection or LITT if feasible; lomustine; bevacizumab for oedema/steroid sparing; re-irradiation; clinical trial (CAR-T, FUS-BBB, vaccines) strongly preferred.

   Lomustine (CCNU)Bevacizumab (glioblastoma use)Laser interstitial thermal therapy (LITT)CAR-T for glioma (IL13Rα2, GD2, EGFRvIII, multi-target)Focused-ultrasound blood-brain barrier openingSBRT / SABR (stereotactic radiotherapy)
4. 4.IDH-mutant grade 2 glioma

   Maximal resection; vorasidenib for residual/recurrent disease (INDIGO); radiotherapy plus PCV or temozolomide for high-risk or progressive disease.

   VorasidenibINDIGO
5. 5.Oligodendroglioma grade 3 / astrocytoma grade 3

   Radiotherapy plus PCV (RTOG 9402, EORTC 26951) or temozolomide (CATNON).

   TemozolomideIMRT / IGRT (modern external beam)
6. 6.H3 K27M diffuse midline glioma

   Radiotherapy; dordaviprone at progression (2025); GD2 CAR-T and ONC201 first-line trials.

   DordaviproneCAR-T for glioma (IL13Rα2, GD2, EGFRvIII, multi-target)
7. 7.Paediatric low-grade glioma

   Resection where safe; chemotherapy (carboplatin/vincristine) or tovorafenib / dabrafenib-trametinib for BRAF-altered relapsed disease; avoid radiation in young children.

   Tovorafenib

Generated from this cancer's standard of care, biomarkers and open problems. Take the group that matches where you are. To tick, add your own and print, open the one-page appointment sheet.

Trials open now for this cancer in OnCo, largest phase first. Joining a trial is a decision like any other: ask what the comparison arm is, whether a placebo is used, and what happens if you leave. The cancer page searches ClinicalTrials.gov live for more.

• A Prospective Pivotal Study to Evaluate the Efficacy and Safety of Avastin® Bevacizumab (BEV) With or Without Microbubble-mediated Focused Ultrasound (FUS-MB) Using NaviFUS System in Recurrent Glioblastoma Multiforme PatientsPhase 3 · recruiting · NCT06496971A Prospective, Randomized, Standard of Care Controlled, Parallel, Open-Label, Multicenter Pivotal Study to Evaluate the Efficacy and Safety of Avastin® in Combination With NaviFUS System Compared With Avastin® Alone for the Treatment of Recurrent Glioblastoma Multiforme (rGBM)
• Beginning Radiation Immediately With GammaTile at GBM Excision Versus Standard of CarePhase 3 · recruiting · NCT07195591Randomized Study of Resection and GammaTile® Followed by Concurrent External Beam Radiation Therapy (EBRT) and Temozolomide (TMZ) and Adjuvant TMZ Versus Standard of Care in Newly Diagnosed Glioblastoma (GBM)
• CODELPhase 3 · active · NCT00887146Newly diagnosed 1p/19q-codeleted glioma: originally radiotherapy with temozolomide against radiotherapy alone or temozolomide alone; redesigned as radiotherapy with temozolomide against radiotherapy with PCV chemotherapy
• DAY101 vs. Standard of Care Chemotherapy in Pediatric Participants With Low-Grade Glioma Requiring First-Line Systemic Therapy (LOGGIC/FIREFLY-2)Phase 3 · active · NCT05566795LOGGIC/FIREFLY-2: A Phase 3, Randomized, International Multicenter Trial of DAY101 Monotherapy Versus Standard of Care Chemotherapy in Patients With Pediatric Low-Grade Glioma Harboring an Activating RAF Alteration Requiring First-Line Systemic Therapy
• EF-41/KEYNOTE D58: Phase 3 Study of Optune Concomitant With Temozolomide Plus Pembrolizumab in Newly Diagnosed GlioblastomaPhase 3 · recruiting · NCT06556563A Phase 3, Randomized, Double-Blind, Placebo-Controlled Study of Optune® (TTFields, 200 kHz) Concomitant With Maintenance Temozolomide and Pembrolizumab Versus Optune® Concomitant With Maintenance Temozolomide and Placebo for the Treatment of Newly Diagnosed Glioblastoma (EF-41/KEYNOTE D58).

Much of what helps in the first weeks is free if you know to ask: testing, helplines, rides and lodging, second opinions, trial travel.

• Free in oncologyFree testing, helplines, rides and lodging, second opinions and trial travel help, with who is eligible.
• Financial helpManufacturer programmes, national schemes and charities by country and product.
• Second opinionExpert centres for this cancer in your country and how referral works.

• Glioma & glioblastoma: the full pageGliomas are now diagnosed by molecular class, and three classes got their first targeted drugs in 2024-25 (vorasidenib for IDH-mutant glioma, tovorafenib for BRAF-altered paediatric glioma, dordaviprone for H3 K27M). Glioblastoma is the hardest to treat: surgery, radiotherapy with temozolomide and tumour treating fields are its backbone, with CAR-T into the brain and focused ultrasound in trials.
• One-page appointment sheetYour questions, the words you may hear, what to bring, and space for the answers. Print it.
• Treatment journey: Newly diagnosedSurgery within days, six weeks of daily radiotherapy with temozolomide tablets, a month off, then six monthly cycles of temozolomide (with the option of a scalp device), and an MRI every two to three months.
• Treatment sequencingWhich treatment tends to follow which, line by line.
• NavigatorStandard of care for your stage, what you have tried, and trials near you.