Glioma Peer to Peer Conference ASCO 2026: New Data, Ongoing Debate
- Updated INDIGO Results: The latest INDIGO results extended median progression-free survival on vorasidenib to 44.1 months versus 11 months on placebo, with time to response now better understood at roughly 15 to 16 months.
- Seizures, Independence, and What Actually Matters to Patients — How seizure control affects driving, work, and daily life — and why it should carry more weight in treatment decisions.
- Fertility, Financial Toxicity, and Shared Decision-Making — For young patients considering long-term IDH inhibition, the conversation goes well beyond efficacy.
- Targeted Therapies for Younger Patients: H3K27M, ONC-201/206, and BRAF — What recent approvals and next-generation agents mean for pediatric and young adult patients with molecularly defined tumors.
- What the Next Five Years Could Look Like — Four leading voices on where neuro-oncology is headed — from liquid biopsies and blood-brain barrier disruption to ADCs and a maturing role for immunotherapy.
ASCO 2026 Glioma Panel: New Data, Ongoing Debate
With nearly four years of follow-up from the INDIGO trial, SurvivorNet brought together a panel of neuro-oncology specialists to explore how the vorasidenib story is evolving—and the new questions it is raising for clinical practice.
Updated results from the INDIGO trial showed that progression-free survival (the length of time a treatment keeps the cancer from advancing) now exceeds 44 months for patients on vorasidenib, compared to just 11 months on the placebo. The data also suggest a reduction in seizure episodes, a welcome relief for patients’ quality of life.
SurvivorNet gathered a panel of experts moderated by Dr. Rimas Lukas that featured Dr. Omar Butt, Dr. Nicolas Gonzalez Castro, and Dr. Heather Leeper.
The conversation quickly moved beyond the data toward a more complicated reality: even as evidence matures, many of the most important clinical questions remain unanswered.
While all four panelists agreed the updated data reinforces confidence in IDH inhibition, they repeatedly returned to a central question: when is the right time to intervene?
Should treatment begin shortly after surgery, even when only microscopic disease remains? Or should therapy be deferred until there is visible radiographic growth?
Dr. Nick Gonzalez Castro, Dana Farber Cancer Institute
Dr. Gonzalez Castro says, “The scale of the scalpel is not the scale of the actual tumor. Even in the hands of our most competent neurosurgical colleagues, we never achieve a complete resection.”
The debate reflects a fundamental challenge: surgeons remove what can be seen, but diffuse gliomas often extend far beyond what MRI captures.
The panel didn’t always agree on timing, but one moment crystallized the underlying logic. When asked whether he would start an IDH inhibitor in a newly resected patient, Dr. Butt was direct. “If it were the question of would I do it for myself or my family member? Yeah, I’d start the drug.”
Dr. Omar Butt, WashU Medicine
The uncertainty becomes even more consequential in younger patients who may live with these tumors for decades.
“This is a very complex and fairly nebulous landscape,” Dr. Lukas said, adding that “it leaves a lot of room for debate.”
The ‘Quality of Life’ Factor
The panel explored how decisions increasingly involve factors beyond tumor control: fertility, family planning, quality of life, financial toxicity, and patient preference.
Seizure control emerged as one of the panel’s most grounded points of agreement. Dr. Leeper was direct about what’s actually at stake.
“When people have a lot of seizures, they can’t drive, they can’t go to work. It’s a huge factor in their social roles and their ability to function in everyday life,” Dr. Leeper told the panel.
Dr. Heather Leeper, University of Chicago Medical Center
Dr. Lukas added that in his own practice, “a flurry of seizure activity may be enough to push me” toward starting treatment, which serves as a clinical tipping point that the trial data alone doesn’t capture.
Dr. Gonzalez Castro entirely reframed the question of medication burden.
“The reality is that most of these patients came to our attention because they were diagnosed after a seizure. All of them are already taking a daily medication [in some cases] twice a day. So I don’t think adding an IDH inhibitor is an increased burden,” Dr. Gonzalez explained.
Looking Ahead
The discussion also looked beyond INDIGO and toward the next phase of IDH-directed therapy. The question is no longer whether IDH inhibition works, but how it fits into broader treatment strategies, including combinations with immunotherapy and vaccines, particularly in higher-grade disease, where monotherapy may not be sufficient.
The broader takeaway: neuro-oncology is entering a new era where the conversation has shifted from proving that targeted therapies work to determining how best to use them. Many of the most consequential decisions remain nuanced, individualized, and still evolving.
