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Immunotherapy Resistance in Glioblastoma
Open accessAbstract
Glioblastoma is the most common malignant primary brain tumor in adults. Despite treatment consisting of surgical resection followed by radiotherapy and adjuvant chemotherapy, survival remains poor at a rate of 26.5% at 2 years. Recent successes in using immunotherapies to treat a number of solid and hematologic cancers have led to a growing interest in harnessing the immune system to target glioblastoma. Several studies have examined the efficacy of various immunotherapies, including checkpoint inhibitors, vaccines, adoptive transfer of lymphocytes, and oncolytic virotherapy in both pre-clinical and clinical settings. However, these therapies have yielded mixed results at best when applied to glioblastoma. While the initial failures of immunotherapy were thought to reflect the immunoprivileged environment of the brain, more recent studies have revealed immune escape mechanisms created by the tumor itself and adaptive resistance acquired in response to therapy. Several of these resistance mechanisms hijack key signaling pathways within the immune system to create a protumoral microenvironment. In this review, we discuss immunotherapies that have been trialed in glioblastoma, mechanisms of tumor resistance, and strategies to sensitize these tumors to immunotherapies. Insights gained from the studies summarized here may help pave the way for novel therapies to overcome barriers that have thus far limited the success of immunotherapy in glioblastoma.
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“GBM immunoresistance may also be acquired in response to therapy, through changes in checkpoint expression, epigenetic changes, and loss of tumour antigen expression [10].”
From Preclinical development of an mRNA-based multiepitope immunotherapeutic for glioblastoma (2025) · cites this paper as [10]
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“Tumour cell heterogeneity and an immunosuppressive microenvironment contribute to primary GBM immunoresistance, which dampens anti-tumour responses by macrophages and T cells [7, 10].”
From Preclinical development of an mRNA-based multiepitope immunotherapeutic for glioblastoma (2025) · cites this paper as [10]
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Research works printed but not linked: 16
- Bristol-Myers Squibb, 2020, A Randomized Phase 3 Single Blind Study of Temozolomide Plus Radiation Therapy Combined with Nivolumab or Placebo in Newly Diagnosed Adult Subjects with MGMT-Methylated (Tumor O6-Methylguanine DNA Methyltransferase) Glioblastoma
- Bristol-Myers Squibb, 2020, A Randomized, Double-Blind Phase 2/3 Study of Relatlimab Combined with Nivolumab versus Nivolumab in Participants with Previously Untreated Metastatic or Unresectable Melanoma
- DNAtrix, 2021, Announces Positive Data from Phase 2 CAPTIVE (KEYNOTE-192) Study with DNX-2401 in Patients with Recurrent Glioblastoma Highlighted in an Oral Late-Breaking Presentation during Society for Neuro-Oncology (SNO) Annual Meeting
- Hoag Memorial Hospital Presbyterian, 2013, Phase II Trial of Intralesional Adoptive Cellular Therapy of Glioblastoma with Interleukin-2-Stimulated Lymphocytes
- 2021, Inc. A Multicenter Phase 2 Study of Oncolytic Polio/Rhinovirus Recombinant (PVSRIPO) in Recurrent WHO Grade IV Malignant Glioma Patients
- Ludwig Institute for Cancer Research, 2021, Phase 2 Study to Evaluate the Clinical Efficacy and Safety of MEDI4736 in Patients with Glioblastoma (GBM)
- Md Gkf, 2021, Phase II Clinical Trial of HSV G207 with a Single 5 Gy Radiation Dose in Children with Recurrent High-Grade Glioma
- Md Jm, 2021, A Phase 1 Study of M032 (NSC 733972), a Genetically Engineered HSV-1 Expressing IL-12, in Patients with Recurrent/Progressive Glioblastoma Multiforme, Anaplastic Astrocytoma, or Gliosarcoma
- Md Pyw, 2021, A Phase Ib Clinical Trial to Evaluate Early Immunologic Pharmacodynamic Parameters Following Neoadjuvant Anti-PD-1 (Nivolumab), or the Combination of Anti-PD-1 Plus Anti-CTLA-4 (Nivolumab Plus Ipilimumab) in Patients with Surgically Accessible Glioblastoma
- Md Yy, 2021, The Safety and Efficacy Study of Autologous Tumor-Infiltrating T LymphocyteTILnd Transgenic Modified TIL Cells Adoptive Therapies for Patients with Glioblastoma Multiforme
- MediciNova, 2021, Phase 1b/2a Single-Center, Open-Label, Dose Escalation Study to Evaluate the Safety, Tolerability, and Efficacy of MN-166 (Ibudilast) and Temozolomide Combination Treatment in Patients with Newly Diagnosed or Recurrent Glioblastoma
- National Cancer Institute Nci, 2021, A Safety Run-In and Phase II Study Evaluating the Efficacy, Safety, and Impact on the Tumor Microenvironment of the Combination of Tocilizumab, Atezolizumab, and Fractionated Stereotactic Radiotherapy in Recurrent Glioblastoma
- National Cancer Institute (Nci), 2020, Phase I Study of Ipilimumab, Nivolumab, and the Combination in Patients with Newly Diagnosed Glioblastoma
- Pediatric Brain Tumor Consortium, 2016, A Phase I Study of Intratumoral/Peritumoral Herpes Simplex Virus-1 Mutant HSV1716 in Patients with Refractory or Recurrent High Grade Gliomas (HGG)
- Uhscc, 2021, Opens New Trial with PVSRIPO a Viralbased Immunotherapy in Combination with Pembrolizumab
- University of Pennsylvania, 2021, A Phase II Study of the Anti-GITR Agonist INCAGN1876 and the PD-1 Inhibitor INCMGA00012 in Combination with Stereotactic Radiosurgery in Recurrent Glioblastoma
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Metadata
- Authors
- Wang, E. J., Chen, J.-S., Jain, S., Morshed, R. A., Haddad, A. F., Gill, S., Beniwal, A. S., & Aghi, M. K.
- Affiliations
- Brown University (US)
- University of California, San Francisco (US)
- Corresponding author
- Aghi, Manish K.
- ORCID
- Venue
- Frontiers in Genetics
- Publisher
- Frontiers Media SA
- Published
- 2021-12-17
- Volume
- 12
- Pages
- 750675-750675
- ISSN
- 1664-8021 (ISSN-L)
- PMC
- PMC8718605
- OpenAlex
- W4200562336
- Cited by
- 34
- References
- 269
- Citations by year
- 2026: 5 · 2025: 7 · 2024: 8 · 2023: 12 · 2022: 2
- FWCI
- 0.78
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Frontiers in Genetics (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- eScholarship (California Digital Library) (submittedVersion, cc-by)
- Funders
- National Cancer Institute (R01CA227136)
- National Institute of Neurological Disorders and Stroke (R01NS079697)
- Topics
- Health Sciences › Medicine › Oncology › Glioma Diagnosis and Treatment
- Health Sciences › Medicine › Oncology › Cancer Immunotherapy and Biomarkers
- Life Sciences › Immunology and Microbiology › Immunology › Immunotherapy and Immune Responses
- Keywords
- glioblastoma, immunotherapy resistance, immune checkpoint inhibitors, cancer vaccines, adoptive immunotherapy, oncolytic virotherapy, tumor immune evasion, tumor microenvironment, immune privilege, adaptive resistance, radiosensitization
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