Table 2. Open in new tab Summary of...

Statements where consensus was achieved.
General statement
There is benefit in applying universal definitions of growth across pLGG molecular subtypes (ie, NF1/BRAFV600E/BRAF fusion, etc.)	22/31	71
Universal definitions in growth should be applied across all RAS/MAPK inhibitors	27/31	87
When interpreting growth, timing, scan sequences, and slice thickness should follow pLGG RAPNO criteria.	29/31	93.5
Resistance
The scan which demonstrates the best recorded MRI response while on MAPK inhibitor therapy is considered the best can for comparison	17/33	52	19/26	73
Resistance is defined as ≥25% tumor growth while on MAPK inhibitor therapy. (as per pLGG RAPNO criteria ie, product of biperpendicular diameters)	33/33	100
Development of new metastatic disease while continuing MAPK inhibitor therapy is defined as resistance	28/33	85
Rebound
The last MRI scan while on MAPK inhibitor therapy should be the scan which is used to calculate percentage growth in tumor after stopping MAPK inhibitor therapy	26/31	84
Rapid growth (rebound) is defined as ≥ 25% growth in tumor in 3 months following cessation of MAPK inhibitor therapy	29/31	88
Development of new metastatic disease after stopping MAPK inhibitor therapy is NOT considered rebound growth, but is rather considered progression	18/31	52	21/26	80
In the definition of rebound growth, if a patient is rechallenged with MAPK inhibitor therapy after rebound growth, they should demonstrate response within 6 months of rechallenging with MAPK inhibitor therapy.	14/31	45	25/25	100
Regrowth/recurrence
The last MRI while on MAPK therapy should be the scan which is used to calculate percentage growth in the tumor after stopping MAPK inhibitor therapy.	24/31	77.4
Recurrence regrowth should be mutually exclusive from rebound growth	27/31	87.1
If the tumor grows more than 6 months after cessation of MAPK inhibitor therapy, this should be considered to be classical recurrence/ progression and NOT rebound growth.	22/31	71

Statements where consensus was achieved.

Consensus statement

Round 1 Delphi

Round 2 Delphi

% agreement

General statement

There is benefit in applying universal definitions of growth across pLGG molecular subtypes (ie, NF1/BRAFV600E/BRAF fusion, etc.)

22/31

Universal definitions in growth should be applied across all RAS/MAPK inhibitors

27/31

When interpreting growth, timing, scan sequences, and slice thickness should follow pLGG RAPNO criteria.

29/31

93.5

Resistance

The scan which demonstrates the best recorded MRI response while on MAPK inhibitor therapy is considered the best can for comparison

17/33

19/26

Resistance is defined as ≥25% tumor growth while on MAPK inhibitor therapy. (as per pLGG RAPNO criteria ie, product of biperpendicular diameters)

33/33

100

Development of new metastatic disease while continuing MAPK inhibitor therapy is defined as resistance

28/33

Rebound

The last MRI scan while on MAPK inhibitor therapy should be the scan which is used to calculate percentage growth in tumor after stopping MAPK inhibitor therapy

26/31

Rapid growth (rebound) is defined as ≥ 25% growth in tumor in 3 months following cessation of MAPK inhibitor therapy

29/31

Development of new metastatic disease after stopping MAPK inhibitor therapy is NOT considered rebound growth, but is rather considered progression

18/31

21/26

In the definition of rebound growth, if a patient is rechallenged with MAPK inhibitor therapy after rebound growth, they should demonstrate response within 6 months of rechallenging with MAPK inhibitor therapy.

14/31

25/25

100

Regrowth/recurrence

The last MRI while on MAPK therapy should be the scan which is used to calculate percentage growth in the tumor after stopping MAPK inhibitor therapy.

24/31

77.4

Recurrence regrowth should be mutually exclusive from rebound growth

27/31

87.1

If the tumor grows more than 6 months after cessation of MAPK inhibitor therapy, this should be considered to be classical recurrence/ progression and NOT rebound growth.

22/31

Statements where consensus was achieved.
General statement
There is benefit in applying universal definitions of growth across pLGG molecular subtypes (ie, NF1/BRAFV600E/BRAF fusion, etc.)	22/31	71
Universal definitions in growth should be applied across all RAS/MAPK inhibitors	27/31	87
When interpreting growth, timing, scan sequences, and slice thickness should follow pLGG RAPNO criteria.	29/31	93.5
Resistance
The scan which demonstrates the best recorded MRI response while on MAPK inhibitor therapy is considered the best can for comparison	17/33	52	19/26	73
Resistance is defined as ≥25% tumor growth while on MAPK inhibitor therapy. (as per pLGG RAPNO criteria ie, product of biperpendicular diameters)	33/33	100
Development of new metastatic disease while continuing MAPK inhibitor therapy is defined as resistance	28/33	85
Rebound
The last MRI scan while on MAPK inhibitor therapy should be the scan which is used to calculate percentage growth in tumor after stopping MAPK inhibitor therapy	26/31	84
Rapid growth (rebound) is defined as ≥ 25% growth in tumor in 3 months following cessation of MAPK inhibitor therapy	29/31	88
Development of new metastatic disease after stopping MAPK inhibitor therapy is NOT considered rebound growth, but is rather considered progression	18/31	52	21/26	80
In the definition of rebound growth, if a patient is rechallenged with MAPK inhibitor therapy after rebound growth, they should demonstrate response within 6 months of rechallenging with MAPK inhibitor therapy.	14/31	45	25/25	100
Regrowth/recurrence
The last MRI while on MAPK therapy should be the scan which is used to calculate percentage growth in the tumor after stopping MAPK inhibitor therapy.	24/31	77.4
Recurrence regrowth should be mutually exclusive from rebound growth	27/31	87.1
If the tumor grows more than 6 months after cessation of MAPK inhibitor therapy, this should be considered to be classical recurrence/ progression and NOT rebound growth.	22/31	71

Statements where consensus is not reached.
When considering an optimal timeframe to perform the first scan after discontinuing MAPK therapy, do you perform the next scan more than 8 weeks and less than or equal to 12 weeks after stopping MAPK inhibitor therapy. (The other option was to perform the next scan less than 8 weeks after stopping MAPK inhibitor therapy.)	18/31	58	17/25	68
In order to differentiate between a tumor that has acquired resistance to MAPK inhibitor therapy versus rebound growth, but remains responsive to MAPK inhibitors, it is beneficial to rechallenge the patient with MAPK inhibitor to confirm rebound growth.	14/31	45	15/25	60
There is utility in providing consensus radiographic-only definitions of pLGG growth as a first step while in parallel establishing clinical/ functional definitions of progression?	20/31	65	16/25	64

Statements where consensus is not reached.

Statement

Round 1 Delphi

Round 2 Delphi

% agreement

When considering an optimal timeframe to perform the first scan after discontinuing MAPK therapy, do you perform the next scan more than 8 weeks and less than or equal to 12 weeks after stopping MAPK inhibitor therapy. (The other option was to perform the next scan less than 8 weeks after stopping MAPK inhibitor therapy.)

18/31

17/25

In order to differentiate between a tumor that has acquired resistance to MAPK inhibitor therapy versus rebound growth, but remains responsive to MAPK inhibitors, it is beneficial to rechallenge the patient with MAPK inhibitor to confirm rebound growth.

14/31

15/25

There is utility in providing consensus radiographic-only definitions of pLGG growth as a first step while in parallel establishing clinical/ functional definitions of progression?

20/31

16/25

Statements where consensus is not reached.
When considering an optimal timeframe to perform the first scan after discontinuing MAPK therapy, do you perform the next scan more than 8 weeks and less than or equal to 12 weeks after stopping MAPK inhibitor therapy. (The other option was to perform the next scan less than 8 weeks after stopping MAPK inhibitor therapy.)	18/31	58	17/25	68
In order to differentiate between a tumor that has acquired resistance to MAPK inhibitor therapy versus rebound growth, but remains responsive to MAPK inhibitors, it is beneficial to rechallenge the patient with MAPK inhibitor to confirm rebound growth.	14/31	45	15/25	60
There is utility in providing consensus radiographic-only definitions of pLGG growth as a first step while in parallel establishing clinical/ functional definitions of progression?	20/31	65	16/25	64

Table 2.

Open in new tab

Summary of Delphi Round 1 and 2 Survey Responses

Statements where consensus was achieved.
Consensus statement	Round 1 Delphi		Round 2 Delphi
Consensus statement	N	% agreement	N	% agreement
General statement
There is benefit in applying universal definitions of growth across pLGG molecular subtypes (ie, NF1/BRAFV600E/BRAF fusion, etc.)	22/31	71
Universal definitions in growth should be applied across all RAS/MAPK inhibitors	27/31	87
When interpreting growth, timing, scan sequences, and slice thickness should follow pLGG RAPNO criteria.	29/31	93.5
Resistance
The scan which demonstrates the best recorded MRI response while on MAPK inhibitor therapy is considered the best can for comparison	17/33	52	19/26	73
Resistance is defined as ≥25% tumor growth while on MAPK inhibitor therapy. (as per pLGG RAPNO criteria ie, product of biperpendicular diameters)	33/33	100
Development of new metastatic disease while continuing MAPK inhibitor therapy is defined as resistance	28/33	85
Rebound
The last MRI scan while on MAPK inhibitor therapy should be the scan which is used to calculate percentage growth in tumor after stopping MAPK inhibitor therapy	26/31	84
Rapid growth (rebound) is defined as ≥ 25% growth in tumor in 3 months following cessation of MAPK inhibitor therapy	29/31	88
Development of new metastatic disease after stopping MAPK inhibitor therapy is NOT considered rebound growth, but is rather considered progression	18/31	52	21/26	80
In the definition of rebound growth, if a patient is rechallenged with MAPK inhibitor therapy after rebound growth, they should demonstrate response within 6 months of rechallenging with MAPK inhibitor therapy.	14/31	45	25/25	100
Regrowth/recurrence
The last MRI while on MAPK therapy should be the scan which is used to calculate percentage growth in the tumor after stopping MAPK inhibitor therapy.	24/31	77.4
Recurrence regrowth should be mutually exclusive from rebound growth	27/31	87.1
If the tumor grows more than 6 months after cessation of MAPK inhibitor therapy, this should be considered to be classical recurrence/ progression and NOT rebound growth.	22/31	71

Statements where consensus was achieved.
Consensus statement	Round 1 Delphi		Round 2 Delphi
Consensus statement	N	% agreement	N	% agreement
General statement
There is benefit in applying universal definitions of growth across pLGG molecular subtypes (ie, NF1/BRAFV600E/BRAF fusion, etc.)	22/31	71
Universal definitions in growth should be applied across all RAS/MAPK inhibitors	27/31	87
When interpreting growth, timing, scan sequences, and slice thickness should follow pLGG RAPNO criteria.	29/31	93.5
Resistance
The scan which demonstrates the best recorded MRI response while on MAPK inhibitor therapy is considered the best can for comparison	17/33	52	19/26	73
Resistance is defined as ≥25% tumor growth while on MAPK inhibitor therapy. (as per pLGG RAPNO criteria ie, product of biperpendicular diameters)	33/33	100
Development of new metastatic disease while continuing MAPK inhibitor therapy is defined as resistance	28/33	85
Rebound
The last MRI scan while on MAPK inhibitor therapy should be the scan which is used to calculate percentage growth in tumor after stopping MAPK inhibitor therapy	26/31	84
Rapid growth (rebound) is defined as ≥ 25% growth in tumor in 3 months following cessation of MAPK inhibitor therapy	29/31	88
Development of new metastatic disease after stopping MAPK inhibitor therapy is NOT considered rebound growth, but is rather considered progression	18/31	52	21/26	80
In the definition of rebound growth, if a patient is rechallenged with MAPK inhibitor therapy after rebound growth, they should demonstrate response within 6 months of rechallenging with MAPK inhibitor therapy.	14/31	45	25/25	100
Regrowth/recurrence
The last MRI while on MAPK therapy should be the scan which is used to calculate percentage growth in the tumor after stopping MAPK inhibitor therapy.	24/31	77.4
Recurrence regrowth should be mutually exclusive from rebound growth	27/31	87.1
If the tumor grows more than 6 months after cessation of MAPK inhibitor therapy, this should be considered to be classical recurrence/ progression and NOT rebound growth.	22/31	71

Statements where consensus is not reached.
Statement	Round 1 Delphi		Round 2 Delphi
Statement	N	% agreement	N	% agreement
When considering an optimal timeframe to perform the first scan after discontinuing MAPK therapy, do you perform the next scan more than 8 weeks and less than or equal to 12 weeks after stopping MAPK inhibitor therapy. (The other option was to perform the next scan less than 8 weeks after stopping MAPK inhibitor therapy.)	18/31	58	17/25	68
In order to differentiate between a tumor that has acquired resistance to MAPK inhibitor therapy versus rebound growth, but remains responsive to MAPK inhibitors, it is beneficial to rechallenge the patient with MAPK inhibitor to confirm rebound growth.	14/31	45	15/25	60
There is utility in providing consensus radiographic-only definitions of pLGG growth as a first step while in parallel establishing clinical/ functional definitions of progression?	20/31	65	16/25	64

Statements where consensus is not reached.
Statement	Round 1 Delphi		Round 2 Delphi
Statement	N	% agreement	N	% agreement
When considering an optimal timeframe to perform the first scan after discontinuing MAPK therapy, do you perform the next scan more than 8 weeks and less than or equal to 12 weeks after stopping MAPK inhibitor therapy. (The other option was to perform the next scan less than 8 weeks after stopping MAPK inhibitor therapy.)	18/31	58	17/25	68
In order to differentiate between a tumor that has acquired resistance to MAPK inhibitor therapy versus rebound growth, but remains responsive to MAPK inhibitors, it is beneficial to rechallenge the patient with MAPK inhibitor to confirm rebound growth.	14/31	45	15/25	60
There is utility in providing consensus radiographic-only definitions of pLGG growth as a first step while in parallel establishing clinical/ functional definitions of progression?	20/31	65	16/25	64

Bold represent consensus achieved where % agreement was equivalent of greater than 70%.

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