Eflornithine + Lomustine Extends Survival in Glioma Subtype

A Turning Point for Glioma Treatment: How Molecular Profiling is Redefining Recurrent Astrocytoma Care

Mar. 23, 2026 at 5:22am

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A phase 3 STELLAR trial has demonstrated the significant benefit of adding eflornithine to standard lomustine therapy for patients with recurrent IDH-mutant grade 3 astrocytoma. The study found that this combination therapy substantially improved both overall survival and progression-free survival in this specific glioma subtype.

Why it matters

For decades, recurrent high-grade gliomas have presented a formidable challenge in oncology, characterized by limited treatment options and often, poor outcomes. The STELLAR trial's findings signal a potential paradigm shift, particularly for patients with recurrent IDH-mutant grade 3 astrocytoma, by offering a new targeted therapy approach.

The details

The STELLAR trial (NCT02796261) involved 343 patients across multiple international sites, including Cleveland Clinic. Participants with grade 3 astrocytoma, experiencing recurrence after initial treatment with radiation and temozolomide, were randomized to receive either lomustine alone or a combination of lomustine and eflornithine. While the trial didn't show a broad survival benefit across all patients, a detailed subset analysis revealed compelling results for those with IDH-mutant grade 3 astrocytomas without the CDKN2A/B homozygous deletion. In this group, median overall survival increased from 23.5 months with lomustine alone to 34.9 months with the addition of eflornithine, and progression-free survival more than doubled, rising from 7.2 months to 15.8 months.

  • The STELLAR trial was published in the Journal of Clinical Oncology in 2026.

The players

STELLAR Trial

A phase 3 clinical trial that evaluated the combination of eflornithine and lomustine for the treatment of recurrent grade 3 astrocytoma.

Dr. David Peereboom

A co-investigator in the STELLAR trial from Cleveland Clinic's Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center.

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What they’re saying

“This approach is particularly effective in slower-growing tumors, like grade 3 astrocytomas, where the cytostatic effect has more time to exert its influence.”

— Dr. David Peereboom, Co-investigator, STELLAR Trial

What’s next

Researchers are exploring the potential of targeted therapies for other glioma subtypes, as well as investigating synergistic combinations of targeted agents, immunotherapies, and conventional chemotherapy.

The takeaway

The STELLAR trial's findings are paving the way for a more personalized approach to glioma treatment, where molecular profiling will become increasingly crucial in identifying patients who are most likely to benefit from specific therapies. This represents a significant step forward in the fight against recurrent astrocytoma.