Neoadjuvant immune checkpoint inhibition in the management of glioblastoma: Exploring a new frontier

Frontiers in Immunology

Immunology

Xiaoran Zhang¹  Constantinos G. Hadjipanayis¹  Gary Kohanbash¹  Alexandra C. Dubinsky²  John P. Bielanin²  Corbin Darling³  Stephen C. Frederico³ 

[1] Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, United States;University of Pittsburgh School of Medicine, Pittsburgh, PA, United States;University of Pittsburgh School of Medicine, Pittsburgh, PA, United States;Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, United States;

关键词: glioblastoma;    GBM;    immunotherapy;    ICI;    neoadjuvant;    brain;   

DOI  :  10.3389/fimmu.2023.1057567

 received in 2022-09-29, accepted in 2023-02-03,  发布年份 2023

来源: Frontiers

【 摘 要 】

Brain tumors are one of the leading causes of cancer related death in both the adult and pediatric patient population. Gliomas represent a cohort of brain tumors derived from glial cell lineages which include astrocytomas, oligodendrogliomas and glioblastomas (GBMs). These tumors are known to grow aggressively and have a high lethality with GBM being the most aggressive tumor in this group. Currently, few treatment options exist for GBM outside of surgical resection, radiation therapy and chemotherapy. While these measures have been shown to marginally improve patient survival, patients, especially those diagnosed with GBM, often experience a recurrence of their disease. Following disease recurrence, treatment options become more limited as additional surgical resections can pose life threatening risk to the patient, patients may be ineligible for additional radiation, and the recurrent tumor may be resistant to chemotherapy. Immune checkpoint inhibitors (ICIs) have revolutionized the field of cancer immunotherapy as many patients with cancers residing outside the central nervous system (CNS) have experienced a survival benefit from this treatment modality. It has often been observed that this survival benefit is increased following neoadjuvant administration of immune checkpoint inhibitors as tumor antigen is still present in the patient which enables a more robust anti-tumor immune response. Interestingly, results for ICI-based studies for patients with GBM have been largely disappointing which is a stark contrast from the success this treatment modality has had in non-central nervous system cancers. In this review, we will discuss the various benefits of neoadjuvant immune checkpoint inhibition such as how this approach reduces tumor burden and allows for a greater induction of an anti-tumor immune response. Additionally, we will discuss several non-CNS cancers where neoadjuvant immune checkpoint inhibition has been successful and discuss why we believe this approach may provide a survival benefit for GBM patients. We hope this manuscript will foster future studies aimed at exploring whether this approach may be beneficial for patients diagnosed with GBM.

【 授权许可】

Unknown   
Copyright © 2023 Frederico, Darling, Bielanin, Dubinsky, Zhang, Hadjipanayis and Kohanbash