Carolinas Pathology, Atrium Health Carolinas Medical Center, Charlotte, NC, USA.
Department of Pathology and Laboratory Medicine, Children's Healthcare of Atlanta and Emory University, Atlanta, GA, USA.
J Neurooncol. 2022 Jun;158(2):179-224. doi: 10.1007/s11060-022-04005-8. Epub 2022 Jun 1.
These recommendations apply to adult patients with progressive or recurrent glioblastoma (GBM).
For adult patients with progressive glioblastoma does testing for Isocitrate Dehydrogenase (IDH) 1 or 2 mutations provide new additional management or prognostic information beyond that derived from the tumor at initial presentation?
Level III: Repeat IDH mutation testing is not necessary if the tumor is histologically similar to the primary tumor and the patient's clinical course is as expected.
For adult patients with progressive glioblastoma does repeat testing for MGMT promoter methylation provide new or additional management or prognostic information beyond that derived from the tumor at initial presentation and what methods of detection are optimal?
Level III: Repeat MGMT promoter methylation is not recommended.
For adult patients with progressive glioblastoma does EGFR amplification or mutation testing provide management or prognostic information beyond that provided by histologic analysis and if performed on previous tissue samples, does it need to be repeated?
Level III: In cases that are difficult to classify as glioblastoma on histologic features EGFR amplification testing may help in classification. If a previous EGFR amplification was detected, repeat testing is not necessary. Repeat EGFR amplification or mutational testing may be recommended in patients in which target therapy is being considered.
For adult patients with progressive glioblastoma does large panel or whole genome sequencing provide management or prognostic information beyond that derived from histologic analysis?
Level III: Primary or repeat large panel or whole genome sequencing may be considered in patients who are eligible or interested in molecularly guided therapy or clinical trials.
For adult patients with progressive glioblastoma should immune checkpoint biomarker testing be performed to provide management and prognostic information beyond that obtained from histologic analysis?
Level III: The current evidence does not support making PD-L1 or mismatch repair (MMR) enzyme activity a component of standard testing.
For adult patients with progressive glioblastoma are there meaningful biomarkers for bevacizumab responsiveness and does their assessment provide additional information for tumor management and prognosis beyond that learned by standard histologic analysis?
Level III: No established Bevacizumab biomarkers are currently available based upon the inclusion criteria of this guideline.
这些建议适用于患有进行性或复发性胶质母细胞瘤（GBM）的成年患者。
对于患有进行性胶质母细胞瘤的成年患者，检测异柠檬酸脱氢酶（IDH）1 或 2 突变是否除了原发肿瘤提供的信息外，还能提供新的治疗或预后信息？
III 级：如果肿瘤组织学与原发性肿瘤相似，且患者的临床过程符合预期，则无需重复进行 IDH 突变检测。
对于患有进行性胶质母细胞瘤的成年患者，重复检测 MGMT 启动子甲基化是否除了原发肿瘤提供的信息外，还能提供新的治疗或预后信息，以及哪种检测方法最佳？
III 级：不建议重复进行 MGMT 启动子甲基化检测。
对于患有进行性胶质母细胞瘤的成年患者，表皮生长因子受体（EGFR）扩增或突变检测是否除了组织学分析提供的信息外，还能提供治疗或预后信息，如果之前进行过组织样本检测，是否需要重复检测？
III 级：在组织学特征上难以归类为胶质母细胞瘤的情况下，EGFR 扩增检测可能有助于分类。如果之前检测到 EGFR 扩增，则无需重复检测。如果正在考虑靶向治疗，则可能需要重复 EGFR 扩增或突变检测。
对于患有进行性胶质母细胞瘤的成年患者，大面板或全基因组测序是否除了组织学分析提供的信息外，还能提供治疗或预后信息？
III 级：对于有资格或有兴趣接受分子指导治疗或临床试验的患者，可考虑进行原发性或复发性大面板或全基因组测序。
对于患有进行性胶质母细胞瘤的成年患者，是否应该进行免疫检查点生物标志物检测，以提供除组织学分析获得的信息外的治疗和预后信息？
III 级：目前的证据不支持将 PD-L1 或错配修复（MMR）酶活性作为标准检测的一部分。
对于患有进行性胶质母细胞瘤的成年患者，是否存在有意义的贝伐单抗反应生物标志物，其评估是否除了标准组织学分析所获得的信息外，还能为肿瘤治疗和预后提供额外信息？
III 级：根据本指南的纳入标准，目前尚无贝伐单抗的既定生物标志物。
