ASCO 2025 | Novel EANO guidelines on testing for targeted therapies in CNS tumors

That guideline was basically trying to fill in the uncertainty and lack of knowledge that most clinicians have. We have so much diagnostic possibilities nowadays with targeted glioma sequencing, methylation arrays, whole genome sequencing, whole exome sequencing. And people are asking what they should do. What we have tried to do in that guideline is to come up with the evidence what’s meaningful and what’s not meaningful. And the sober fact is that there is a handful of targets for which there is really evidence that looking for that target can make a difference in the life of a patient. So at this point in time, the only target that’s really making a difference in terms of therapeutic exploit is the BRAF mutation. Most of the dedicated tumor panels now have this on board. There is still work ongoing on the FGFR mutations and fusions. Today there was again a presentation that shows that there may be some limited efficacy of that. There was the NTRK fusions that are potentially treatable, but in adult patients the results of that therapeutic approach is still quite meager. And then the possibility of giving patients mismatch repair deficiencies, anti-PD-1 therapies, immunotherapies. But here again, the efficacy data are still quite modest. So for most of the targets that are present, it’s only rational to test for it if you have a trial that is available that you can refer your patient to. For the other targets there is just really no effective therapeutic strategy. You should test for BRAF because it makes a difference. For NTRK, FGFR, if you have a trial in your neighborhood, it makes sense to test for it. And the same thing holds for mismatch repair deficiencies. There are low numbers of patients that respond, so I guess testing for that is reasonable.

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