Adult diffuse glioma therapy reference (2026)
Reference snapshot of adult diffuse glioma therapy across IDH-mutant grade 2/3 disease, glioblastoma first-line, and recurrent disease.
Adult diffuse glioma therapy in 2026 organises around molecular subtype.
IDH-mutant grade 2 and 3 glioma: vorasidenib (IDH inhibitor) is now approved for grade 2 IDH-mutant glioma after surgery. Standard radiation plus temozolomide or PCV chemotherapy remains in use for higher-grade or progressive disease.
Glioblastoma (IDH-wildtype, grade 4) first-line: maximal safe surgical resection, followed by radiation plus concurrent and adjuvant temozolomide (the Stupp protocol). Tumour-treating fields (TTFields) are added during and after maintenance temozolomide. MGMT methylation status guides decisions in elderly patients.
Recurrent glioblastoma: bevacizumab is widely used. Lomustine, regorafenib, and re-irradiation are options in selected patients. Late-stage programs (immunotherapy combinations including dendritic-cell vaccines, CAR-T cell therapy approaches, focused-ultrasound-mediated blood-brain barrier opening for drug delivery, mechanism-targeted therapy in molecularly-defined subgroups) are reading out.
The diagnostic-and-molecular-pathway question matters. Modern glioma classification combines histology with IDH status, 1p/19q codeletion, MGMT methylation, and increasingly broader molecular profiling; access to comprehensive molecular workup is uneven across health systems.
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