Continuing Multidisciplinary Care Throughout DMG Treatment Sequencing

Funding support provided by Chimerix/Jazz Pharmaceuticals. Content independently developed and published by OncLive.

Tumor boards play a central role in the management of diffuse midline gliomas, providing a venue for multidisciplinary input at critical points in the patient’s care. Because these tumors are rare, even large brain tumor centers have limited individual experience, making collaborative review essential. Presenting cases at tumor board before starting therapy allows the team to anticipate complications and ensure a coordinated plan. Tumor boards are equally valuable during follow-up, particularly when interpreting radiographic changes. Distinguishing true tumor progression from treatment-related effects is often extremely challenging, and collective expertise helps avoid missteps in clinical decision-making.

Serial imaging reviews are an extension of this process and ensure consistency in multidisciplinary care. By revisiting initial scans and carefully comparing them to follow-up images, radiologists and oncologists can detect subtle changes and patterns in tumor behavior that might otherwise be overlooked in a busy practice. This is particularly important for midline gliomas, which can present in atypical locations or demonstrate leptomeningeal dissemination. Systematic review at regular intervals—every 6 to 8 weeks in many centers—helps maintain clarity about disease evolution and keeps all members of the care team aligned. These practices reinforce the importance of collaboration and vigilance throughout the treatment course.

Once radiation begins, treatment sequencing typically involves delivering 54 to 60 gray over six weeks, followed by a post-treatment MRI about one month later. At this stage, patients remain in close contact with both neuro-oncology and radiation oncology, and clinical trial enrollment should be prioritized whenever available. Unlike glioblastoma, temozolomide has not shown proven benefit in this setting, and many specialists do not use it as part of the treatment protocol. Instead, the focus is on radiation, supportive care, and clinical trials. For patients with the H3K27M mutation, dordaviprone now provides an FDA-approved therapeutic option, offering a new avenue for management after disease progression.