From the Guidelines
Astrocytomas are primarily caused by genetic mutations, particularly in genes like IDH1, IDH2, TP53, and ATRX, with exposure to ionizing radiation being a confirmed environmental risk factor. The exact cause of astrocytomas remains largely unknown, though several risk factors have been identified [ 1 ]. Genetic mutations play a significant role in their development, and other potential factors include certain chemical exposures and rare genetic syndromes such as neurofibromatosis type 1, Li-Fraumeni syndrome, and tuberous sclerosis.
Management of Astrocytomas
Management of astrocytomas depends on their grade, location, and the patient's overall health.
- Treatment typically involves surgical resection when possible to remove as much tumor as safely feasible.
- For higher-grade tumors, surgery is usually followed by radiation therapy and chemotherapy, with temozolomide being the standard agent [ 1 ].
- The standard of care for IDH-mutant astrocytomas, WHO grade 2 requiring further treatment includes resection as feasible or biopsy followed by involved field radiotherapy and maintenance PCV polychemotherapy [ 1 ].
- Lower-grade astrocytomas may be managed with surgery alone or observation with serial imaging [ 1 ].
- Newer targeted therapies and immunotherapies are emerging for specific molecular subtypes, such as BRAF inhibitors for BRAF-mutated tumors.
- Regular follow-up with MRI scans is essential to monitor for tumor recurrence, and supportive care including anticonvulsants for seizures and steroids (dexamethasone 4-16 mg/day) for cerebral edema may be necessary to manage symptoms [ 1 ].
From the FDA Drug Label
1.2 Refractory Anaplastic Astrocytoma 14.2 Refractory Anaplastic Astrocytoma
The FDA drug label does not answer the question.
From the Research
Causes of Astrocytomas
- The exact causes of astrocytomas are not specified in the provided studies 2, 3, 4, 5, 6.
- However, it is known that astrocytomas are a type of primary brain tumor that arises from astrocytes, a type of glial cell in the brain.
Management of Astrocytomas
- The standard treatment for high-grade astrocytomas includes surgical resection, radiotherapy, and temozolomide chemotherapy 2, 3, 5, 6.
- Temozolomide has been shown to improve survival in patients with newly diagnosed glioblastoma and anaplastic astrocytoma 5, 6.
- Radiation therapy with concurrent and adjuvant temozolomide chemotherapy is the standard-of-care treatment for newly diagnosed glioblastoma 3.
- For patients with recurrent high-grade astrocytomas, treatment options include further cytotoxic therapy, vascular endothelial growth factor (VEGF) inhibitors such as bevacizumab, and investigational treatments including molecularly targeted agents and immunotherapeutic approaches 3, 4.
- Continuous daily dosing of temozolomide has been shown to be effective in some patients with recurrent anaplastic astrocytoma, with a dose-dependent response 4.