Mechanisms underlying the failure of PD-1/PD-L1 blockade in glioblastoma: Therapeutic challenges and opportunities
Glioblastoma (GBM) is a highly aggressive primary brain tumor with a poor prognosis and limited therapeutic options. Although programmed cell death protein 1 (PD-1)/programmed death-ligand 1 (PD-L1) blockade has transformed the treatment of several malignancies, its clinical benefit in GBM remains limited, and the mechanisms underlying this resistance remain poorly understood. This review summarizes the biological roles of the PD-1/PD-L1 axis in the GBM microenvironment, evaluates clinical evidence for immune checkpoint inhibitors, and discusses mechanisms of resistance and strategies to overcome therapeutic resistance. It integrates current preclinical and clinical evidence on PD-1/PD-L1 signaling, the cellular sources of PD-L1, clinical trial outcomes, resistance mechanisms, and emerging combination strategies. We propose a dual-source PD-L1 framework to discuss the potential contributions of tumor cell-derived and immune cell-derived PD-L1 to GBM-mediated immunosuppression and therapeutic response. However, whether these two PD-L1 sources have distinct functional specializations remains unproven and requires further validation through spatial omics analyses and cell-type-specific functional studies. This framework may help explain the limited value of total PD-L1 expression as a single predictive biomarker in GBM. We further outline a multilayer resistance model involving the blood–brain barrier, an immunologically cold tumor microenvironment, and compensatory immunosuppressive networks. Emerging strategies, including optimized treatment timing, microenvironmental modulation, and rational immunotherapy combinations, are also discussed. A deeper understanding of PD-1/PD-L1 biology and multilayered immune resistance may guide the development of more effective immunotherapeutic strategies for GBM.
- Price M, Ballard C, Benedetti J, et al. CBTRUS Statistical Report: Primary Brain and Other Central Nervous System Tumors Diagnosed in the United States in 2017-2021. Neuro Oncol. 2024;26(suppl 6):vi1-vi85. doi: 10.1093/neuonc/noae145
- Stupp R, Mason WP, van den Bent MJ, et al. Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med. 2005;352(10):987-996. doi: 10.1056/NEJMoa043330
- Phillips RE, Soshnev AA, Allis CD. Epigenomic Reprogramming as a Driver of Malignant Glioma. Cancer Cell. 2020;38(5):647-660. doi: 10.1016/j.ccell.2020.08.008
- Wang H, Xu T, Huang Q, Jin W, Chen J. Immunotherapy for Malignant Glioma: Current Status and Future Directions. Trends Pharmacol Sci. 2020;41(2):123-138. doi: 10.1016/j.tips.2019.12.003
- Tan AC, Ashley DM, López GY, Malinzak M, Friedman HS, Khasraw M. Management of glioblastoma: State of the art and future directions. CA Cancer J Clin. 2020;70(4):299-312. doi: 10.3322/caac.21613
- Nava F, Tramacere I, Fittipaldo A, et al. Survival effect of first- and second-line treatments for patients with primary glioblastoma: a cohort study from a prospective registry, 1997-2010. Neuro Oncol. 2014;16(5):719-727. doi: 10.1093/neuonc/not316
- Ser MH, Webb MJ, Sener U, Campian JL. Immune Checkpoint Inhibitors and Glioblastoma: A Review on Current State and Future Directions. J Immunother Precis Oncol. 2024;7(2):97-110. doi: 10.36401/JIPO-23-34
- Karschnia P, Gerritsen JKW, Teske N, et al. The oncological role of resection in newly diagnosed diffuse adult-type glioma defined by the WHO 2021 classification: a Review by the RANO resect group. Lancet Oncol. 2024;25(9):e404-e419. doi: 10.1016/S1470-2045(24)00130-X
- Wach J, Vychopen M, Kühnapfel A, Seidel C, Güresir E. A Systematic Review and Meta-Analysis of Supramarginal Resection versus Gross Total Resection in Glioblastoma: Can We Enhance Progression-Free Survival Time and Preserve Postoperative Safety? Cancers. 2023;15(6):1772. doi: 10.3390/cancers15061772
- Ohaegbulam KC, Assal A, Lazar-Molnar E, Yao Y, Zang X. Human cancer immunotherapy with antibodies to the PD-1 and PD-L1 pathway. Trends Mol Med. 2015;21(1):24-33. doi: 10.1016/j.molmed.2014.10.009
- Lin X, Kang K, Chen P, et al. Regulatory mechanisms of PD-1/PD-L1 in cancers. Mol Cancer. 2024;23(1):108. doi: 10.1186/s12943-024-02023-w
- Boussiotis VA. Molecular and Biochemical Aspects of the PD-1 Checkpoint Pathway. N Engl J Med. 2016;375(18):1767-1778. doi: 10.1056/NEJMra1514296
- Zhu Z, Zhang H, Chen B, et al. PD-L1-Mediated Immunosuppression in Glioblastoma Is Associated With the Infiltration and M2-Polarization of Tumor-Associated Macrophages. Front Immunol. 2020;11:588552. doi: 10.3389/fimmu.2020.588552
- Musatova O, Kumar V, Vinogradov K, Rubtsov Y. Immune checkpoints in immune response to glioma: two sides of the same coin. Front Immunol. 2025;16:1639521. doi: 10.3389/fimmu.2025.1639521
- Reinfeld BI, Madden MZ, Wolf MM, et al. Cell-programmed nutrient partitioning in the tumour microenvironment. Nature. 2021;593(7858):282-288. doi: 10.1038/s41586-021-03442-1
- Tang F, Wang Y, Zeng Y, Xiao A, Tong A, Xu J. Tumor-associated macrophage-related strategies for glioma immunotherapy. NPJ Precis Oncol. 2023;7(1):78. doi: 10.1038/s41698-023-00431-7
- Broggi G, Angelico G, Farina J, et al. Tumor-associated microenvironment, PD-L1 expression and their relationship with immunotherapy in glioblastoma, IDH-wild type: A comprehensive review with emphasis on the implications for neuropathologists. Pathol Res Pract. 2024;254:155144. doi: 10.1016/j.prp.2024.155144
- Lin H, Liu C, Hu A, Zhang D, Yang H, Mao Y. Understanding the immunosuppressive microenvironment of glioma: mechanistic insights and clinical perspectives. J Hematol Oncol. 2024;17(1):31. doi: 10.1186/s13045-024-01544-7
- Greenwald AC, Darnell NG, Hoefflin R, et al. Integrative spatial analysis reveals a multi-layered organization of glioblastoma. Cell. 2024;187(10):2485-2501.e26. doi: 10.1016/j.cell.2024.03.029
- Chen T, Liu J, Wang C, et al. ALOX5 contributes to glioma progression by promoting 5-HETE-mediated immunosuppressive M2 polarization and PD-L1 expression of glioma-associated microglia/macrophages. J Immunother Cancer. 2024;12(8):e009492. doi: 10.1136/jitc-2024-009492
- Schweiger MW, Amoozgar Z, Repiton P, et al. Glioblastoma extracellular vesicles modulate immune PD-L1 expression in accessory macrophages upon radiotherapy. iScience. 2024;27(2):108807. doi: 10.1016/j.isci.2024.108807
- Motevasseli M, Darvishi M, Khoshnevisan A, et al. Distinct tumor-TAM interactions in IDH-stratified glioma microenvironments unveiled by single-cell and spatial transcriptomics. Acta Neuropathol Commun. 2024;12(1):133. doi: 10.1186/s40478-024-01837-5
- Zhang Y, Song Q, Cassady K, et al. Blockade of trans PD-L1 interaction with CD80 augments antitumor immunity. Proc Natl Acad Sci U S A. 2023;120(16):e2205085120. doi: 10.1073/pnas.2205085120
- Shergold AL, Millar R, Nibbs RJB. Understanding and overcoming the resistance of cancer to PD-1/PD-L1 blockade. Pharmacol Res. 2019;145:104258. doi: 10.1016/j.phrs.2019.104258
- Gide TN, Quek C, Menzies AM, et al. Distinct Immune Cell Populations Define Response to Anti-PD-1 Monotherapy and Anti-PD-1/Anti-CTLA-4 Combined Therapy. Cancer Cell. 2019;35(2):238-255.e6. doi: 10.1016/j.ccell.2019.01.003
- Ayers M, Lunceford J, Nebozhyn M, et al. IFN-γ-related mRNA profile predicts clinical response to PD-1 blockade. J Clin Invest. 2017;127(8):2930-2940. doi: 10.1172/JCI91190
- Li J, Zhao J, Tan T, et al. Nanoparticle Drug Delivery System for Glioma and Its Efficacy Improvement Strategies: A Comprehensive Review. Int J Nanomedicine. 2020;15:2563-2582. doi: 10.2147/IJN.S243223
- Gao J, Shi LZ, Zhao H, et al. Loss of IFN-γ Pathway Genes in Tumor Cells as a Mechanism of Resistance to Anti-CTLA-4 Therapy. Cell. 2016;167(2):397-404.e9. doi: 10.1016/j.cell.2016.08.069
- Berghoff AS, Kiesel B, Widhalm G, et al. Programmed death ligand 1 expression and tumor-infiltrating lymphocytes in glioblastoma. Neuro Oncol. 2015;17(8):1064-1075. doi: 10.1093/neuonc/nou307
- Nduom EK, Wei J, Yaghi NK, et al. PD-L1 expression and prognostic impact in glioblastoma. Neuro Oncol. 2016;18(2):195-205. doi: 10.1093/neuonc/nov172
- Wang X, Guo G, Guan H, Yu Y, Lu J, Yu J. Challenges and potential of PD-1/PD-L1 checkpoint blockade immunotherapy for glioblastoma. J Exp Clin Cancer Res. 2019;38(1):87. doi: 10.1186/s13046-019-1085-3
- Zhang P, Rashidi A, Zhao J, et al. STING agonist-loaded, CD47/PD-L1-targeting nanoparticles potentiate antitumor immunity and radiotherapy for glioblastoma. Nat Commun. 2023;14(1):1610. doi: 10.1038/s41467-023-37328-9
- Bv H, Jolly MK. Proneural-mesenchymal antagonism dominates the patterns of phenotypic heterogeneity in glioblastoma. iScience. 2024;27(3):109184. doi: 10.1016/j.isci.2024.109184
- Yang HC, Su YK, Yadav VK, Fong IH, Liu HW, Lin CM. The HMGB1-RAGE Axis Drives the Proneural-to-Mesenchymal Transition and Aggressiveness in Glioblastoma. Int J Mol Sci. 2025;26(19):9352. doi: 10.3390/ijms26199352
- White K, Connor K, Meylan M, et al. Identification, validation and biological characterisation of novel glioblastoma tumour microenvironment subtypes: implications for precision immunotherapy. Ann Oncol. 2023;34(3):300-314. doi: 10.1016/j.annonc.2022.11.008
- Hendriksen JD, Locallo A, Maarup S, et al. Immunotherapy drives mesenchymal tumor cell state shift and TME immune response in glioblastoma patients. Neuro Oncol. 2024;26(8):1453-1466. doi: 10.1093/neuonc/noae085
- Weathers SP, Li X, Zhu H, et al. Improved overall survival in an anti-PD-L1 treated cohort of newly diagnosed glioblastoma patients is associated with distinct immune, mutation, and gut microbiome features: a single arm prospective phase I/II trial. Nat Commun. 2025;16(1):3950. doi: 10.1038/s41467-025-56930-7
- Zhao R, Pan Z, Qiu J, et al. Blocking ITGA5 potentiates the efficacy of anti-PD-1 therapy on glioblastoma by remodeling tumor-associated macrophages. Cancer Commun. 2025;45(6):677-701. doi: 10.1002/cac2.70016
- Gonzalez N, Perez Küper M, Garcia Fallit M, et al. Predicting Treatment Outcomes in Glioblastoma: A Risk Score Model for TMZ Resistance and Immune Checkpoint Inhibition. Biology. 2025;14(5):572. doi: 10.3390/biology14050572
- Vimalathas G, Kristensen BW. Expression, prognostic significance and therapeutic implications of PD-L1 in gliomas. Neuropathol Appl Neurobiol. 2022;48(1):e12767. doi: 10.1111/nan.12767
- Horn L, Spigel DR, Vokes EE, et al. Nivolumab Versus Docetaxel in Previously Treated Patients With Advanced Non-Small-Cell Lung Cancer: Two-Year Outcomes From Two Randomized, Open-Label, Phase III Trials (CheckMate 017 and CheckMate 057). J Clin Oncol. 2017;35(35):3924-3933. doi: 10.1200/JCO.2017.74.3062
- Larkin J, Chiarion-Sileni V, Gonzalez R, et al. Combined Nivolumab and Ipilimumab or Monotherapy in Untreated Melanoma. N Engl J Med. 2015;373(1):23-34. doi: 10.1056/NEJMoa1504030
- Ledford H, Else H, Warren M. Cancer immunologists scoop medicine Nobel prize. Nature. 2018;562(7725):20-21. doi: 10.1038/d41586-018-06751-0
- Rotte A, D'Orazi G, Bhandaru M. Nobel committee honors tumor immunologists. J Exp Clin Cancer Res. 2018;37(1):262. doi: 10.1186/s13046-018-0937-6
- Chen YS, Shen CR. Immune checkpoint blockade therapy: the 2014 Tang Prize in Biopharmaceutical Science. Biomed J. 2015;38(1):5-8. doi: 10.4103/2319-4170.151150
- Reardon DA, Brandes AA, Omuro A, et al. Effect of Nivolumab vs Bevacizumab in Patients With Recurrent Glioblastoma: The CheckMate 143 Phase 3 Randomized Clinical Trial. JAMA Oncol. 2020;6(7):1003-1010. doi: 10.1001/jamaoncol.2020.1024
- Reardon DA, Kim TM, Frenel JS, et al. Treatment with pembrolizumab in programmed death ligand 1-positive recurrent glioblastoma: Results from the multicohort phase 1 KEYNOTE-028 trial. Cancer. 2021;127(10):1620-1629. doi: 10.1002/cncr.33378
- Cloughesy TF, Mochizuki AY, Orpilla JR, et al. Neoadjuvant anti-PD-1 immunotherapy promotes a survival benefit with intratumoral and systemic immune responses in recurrent glioblastoma. Nat Med. 2019;25(3):477-486. doi: 10.1038/s41591-018-0337-7
- Frederico SC, Darling C, Bielanin JP, et al. Neoadjuvant immune checkpoint inhibition in the management of glioblastoma: Exploring a new frontier. Front Immunol. 2023;14:1057567. doi: 10.3389/fimmu.2023.1057567
- McFaline-Figueroa JR, Sun L, Youssef GC, et al. Neoadjuvant anti-PD1 immunotherapy for surgically accessible recurrent glioblastoma: clinical and molecular outcomes of a stage 2 single-arm expansion cohort. Nat Commun. 2024;15(1):10757. doi: 10.1038/s41467-024-54326-7
- de Melo SM, Elias Nunes da Silva ME, Torloni MR, et al. Anti-PD-1 and anti-PD-L1 antibodies for glioma. Cochrane Database Syst Rev. 2025;1(1):CD012532. doi: 10.1002/14651858.CD012532.pub2
- Liu Y, Zhou F, Ali H, Lathia JD, Chen P. Immunotherapy for glioblastoma: current state, challenges, and future perspectives. Cell Mol Immunol. 2024;21(12):1354-1375. doi: 10.1038/s41423-024-01226-x
- Sloan AE, Winter K, Gilbert MR, et al. NRG-BN002: Phase I study of ipilimumab, nivolumab, and the combination in patients with newly diagnosed glioblastoma. Neuro Oncol. 2024;26(9):1628-1637. doi: 10.1093/neuonc/noae058
- Lassman AB, Polley MC, Iwamoto FM, et al. Dual Immune Check Point Blockade in MGMT-Unmethylated Newly Diagnosed Glioblastoma: NRG Oncology BN007, a Randomized Phase II/III Clinical Trial. J Clin Oncol. 2025;43(27):3032-3040. doi: 10.1200/JCO-25-00618
- Baskaran AB, Kozel OA, Venkatesh O, et al. Immune Checkpoint Inhibitors in Glioblastoma IDHwt Treatment: A Systematic Review. Cancers. 2024;16(24):4148. doi: 10.3390/cancers16244148
- Goswami S, Raychaudhuri D, Singh P, et al. Myeloid-specific KDM6B inhibition sensitizes glioblastoma to PD1 blockade. Nat Cancer. 2023;4(10):1455-1473. doi: 10.1038/s43018-023-00620-0
- Miller TE, El Farran CA, Couturier CP, et al. Programs, origins and immunomodulatory functions of myeloid cells in glioma. Nature. 2025;640(8060):1072-1082. doi: 10.1038/s41586-025-08633-8
- Akay F, Saleh M. Rational therapeutic targeting of myeloid cells in glioblastoma: challenges and perspectives. Front Immunol. 2025;16:1472710. doi: 10.3389/fimmu.2025.1472710
- Persson ML, Douglas AM, Alvaro F, et al. The intrinsic and microenvironmental features of diffuse midline glioma: Implications for the development of effective immunotherapeutic treatment strategies. Neuro Oncol. 2022;24(9):1408-1422. doi: 10.1093/neuonc/noac117
- Liebner S, Dijkhuizen RM, Reiss Y, Plate KH, Agalliu D, Constantin G. Functional morphology of the blood-brain barrier in health and disease. Acta Neuropathol. 2018;135(3):311-336. doi: 10.1007/s00401-018-1815-1
- Robey RW, Pluchino KM, Hall MD, Fojo AT, Bates SE, Gottesman MM. Revisiting the role of ABC transporters in multidrug-resistant cancer. Nat Rev Cancer. 2018;18(7):452-464. doi: 10.1038/s41568-018-0005-8
- Gomez-Zepeda D, Taghi M, Scherrmann JM, Decleves X, Menet MC. ABC Transporters at the Blood-Brain Interfaces, Their Study Models, and Drug Delivery Implications in Gliomas. Pharmaceutics. 2019;12(1):20. doi: 10.3390/pharmaceutics12010020
- Wang D, Wang C, Wang L, Chen Y. A comprehensive review in improving delivery of small-molecule chemotherapeutic agents overcoming the blood-brain/brain tumor barriers for glioblastoma treatment. Drug Deliv. 2019;26(1):551-565. doi: 10.1080/10717544.2019.1616235
- Shan H, Zheng G, Bao S, et al. Tumor perfusion enhancement by focus ultrasound-induced blood-brain barrier opening to potentiate anti-PD-1 immunotherapy of glioma. Transl Oncol. 2024;49:102115. doi: 10.1016/j.tranon.2024.102115
- Carpentier A, Stupp R, Sonabend AM, et al. Repeated blood-brain barrier opening with a nine-emitter implantable ultrasound device in combination with carboplatin in recurrent glioblastoma: a phase I/II clinical trial. Nat Commun. 2024;15(1):1650. doi: 10.1038/s41467-024-45818-7
- Seas AA, Malla AP, Sharifai N, Winkles JA, Woodworth GF, Anastasiadis P. Microbubble-Enhanced Focused Ultrasound for Infiltrating Gliomas. Biomedicines. 2024;12(6):1230. doi: 10.3390/biomedicines12061230
- Ding XC, Wang LL, Zhang XD, et al. The relationship between expression of PD-L1 and HIF-1α in glioma cells under hypoxia. J Hematol Oncol. 2021;14(1):92. doi: 10.1186/s13045-021-01102-5
- Hu M, Zhu Y, Mu D, et al. Correlation of hypoxia as measured by fluorine-18 fluoroerythronitroimidazole (18F-FETNIM) PET/CT and overall survival in glioma patients. Eur J Nucl Med Mol Imaging. 2020;47(6):1427-1434. doi: 10.1007/s00259-019-04621-z
- Domènech M, Hernández A, Plaja A, Martínez-Balibrea E, Balañà C. Hypoxia: The Cornerstone of Glioblastoma. Int J Mol Sci. 2021;22(22):12608. doi: 10.3390/ijms222212608
- Nakazawa T, Morimoto T, Maeoka R, et al. Characterization of HIF-1α Knockout Primary Human Natural Killer Cells Including Populations in Allogeneic Glioblastoma. Int J Mol Sci. 2024;25(11):5896. doi: 10.3390/ijms25115896
- Espinoza FI, Tankov S, Chliate S, et al. Targeting HIF-2α in glioblastoma reshapes the immune infiltrate and enhances response to immune checkpoint blockade. Cell Mol Life Sci. 2025;82(1):119. doi: 10.1007/s00018-025-05642-8
- Galvez-Cancino F, Navarrete M, Beattie G, et al. Regulatory T cell depletion promotes myeloid cell activation and glioblastoma response to anti-PD1 and tumor-targeting antibodies. Immunity. 2025;58(7):1862-1864. doi: 10.1016/j.immuni.2025.05.019
- Wen PY, van den Bent M, Youssef G, et al. RANO 2.0: Update to the Response Assessment in Neuro-Oncology Criteria for High- and Low-Grade Gliomas in Adults. J Clin Oncol. 2023;41(33):5187-5199. doi: 10.1200/JCO.23.01059
- Urban H, Steidl E, Hattingen E, et al. Immune Checkpoint Inhibitor-Induced Cerebral Pseudoprogression: Patterns and Categorization. Front Immunol. 2022;12:798811. doi: 10.3389/fimmu.2021.798811
- Ibáñez-Juliá MJ, Bataller L, Cabello-Murgui FJ, et al. Clinical and radiological features of pseudoprogression in brain tumors treated with immune checkpoint inhibitors. J Neurooncol. 2025;174(3):779-788. doi: 10.1007/s11060-025-05091-0
- Rhee JY, Ospina Botero JP, Nelson T, et al. Limited evidence of pseudoprogression following immune checkpoint inhibitor (ICI) therapy in glioblastoma. Neurooncol Adv. 2025;8(1):vdaf232. doi: 10.1093/noajnl/vdaf232
- Iwamoto FM, Tanguturi SK, Nayak L, et al. Re-Irradiation Plus Pembrolizumab: A Phase II Study for Patients with Recurrent Glioblastoma. Clin Cancer Res. 2025;31(2):316-327. doi: 10.1158/1078-0432.CCR-24-1629
- Duerinck J, Lescrauwaet L, Dirven I, et al. Intracranial administration of anti-PD-1 and anti-CTLA-4 immune checkpoint-blocking monoclonal antibodies in patients with recurrent high-grade glioma. Neuro Oncol. 2024;26(12):2208-2221. doi: 10.1093/neuonc/noae177
- Lu Y, Liao L, Du K, et al. Clinical activity and safety of sintilimab, bevacizumab, and TMZ in patients with recurrent glioblastoma. BMC Cancer. 2024;24(1):133. doi: 10.1186/s12885-024-11848-z
- Nassiri F, Patil V, Yefet LS, et al. Oncolytic DNX-2401 virotherapy plus pembrolizumab in recurrent glioblastoma: a phase 1/2 trial. Nat Med. 2023;29(6):1370-1378. doi: 10.1038/s41591-023-02347-y
- Bagley SJ, Binder ZA, Lamrani L, et al. Repeated peripheral infusions of anti-EGFRvIII CAR T cells in combination with pembrolizumab show no efficacy in glioblastoma: a phase 1 trial. Nat Cancer. 2024;5(3):517-531. doi: 10.1038/s43018-023-00709-6
- Arrieta VA, Gould A, Kim KS, et al. Ultrasound-mediated delivery of doxorubicin to the brain results in immune modulation and improved responses to PD-1 blockade in gliomas. Nat Commun. 2024;15(1):4698. doi: 10.1038/s41467-024-48326-w
- Kim KS, Habashy K, Gould A, et al. Fc-enhanced anti-CTLA-4, anti-PD-1, doxorubicin, and ultrasound-mediated blood-brain barrier opening: A novel combinatorial immunotherapy regimen for gliomas. Neuro Oncol. 2024;26(11):2044-2060. doi: 10.1093/neuonc/noae135
- Najem H, Lea ST, Tripathi S, et al. STING agonist 8803 reprograms the immune microenvironment and increases survival in preclinical models of glioblastoma. J Clin Invest. 2024;134(12):e175033. doi: 10.1172/JCI175033
- Sato H, Okonogi N, Nakano T. Rationale of combination of anti-PD-1/PD-L1 antibody therapy and radiotherapy for cancer treatment. Int J Clin Oncol. 2020;25(5):801-809. doi: 10.1007/s10147-020-01666-1
- Ene CI, Kreuser SA, Jung M, et al. Anti-PD-L1 antibody direct activation of macrophages contributes to a radiation-induced abscopal response in glioblastoma. Neuro Oncol. 2020;22(5):639-651. doi: 10.1093/neuonc/noz226
- Zeng J, See AP, Phallen J, et al. Anti-PD-1 blockade and stereotactic radiation produce long-term survival in mice with intracranial gliomas. Int J Radiat Oncol Biol Phys. 2013;86(2):343-349. doi: 10.1016/j.ijrobp.2012.12.025
- Shevtsov M, Sato H, Multhoff G, Shibata A. Novel Approaches to Improve the Efficacy of Immuno-Radiotherapy. Front Oncol. 2019;9:156. doi: 10.3389/fonc.2019.00156
- Schatz J, Ladinig A, Fietkau R, et al. Normofractionated irradiation and not temozolomide modulates the immunogenic and oncogenic phenotype of human glioblastoma cell lines. Strahlenther Onkol. 2023;199(12):1140-1151. doi: 10.1007/s00066-022-02028-8
- Yi M, Zheng X, Niu M, Zhu S, Ge H, Wu K. Combination strategies with PD-1/PD-L1 blockade: current advances and future directions. Mol Cancer. 2022;21(1):28. doi: 10.1186/s12943-021-01489-2
- Gandhi L, Rodríguez-Abreu D, Gadgeel S, et al. Pembrolizumab plus Chemotherapy in Metastatic Non-Small-Cell Lung Cancer. N Engl J Med. 2018;378(22):2078-2092. doi: 10.1056/NEJMoa1801005
- Paz-Ares L, Luft A, Vicente D, et al. Pembrolizumab plus Chemotherapy for Squamous Non-Small-Cell Lung Cancer. N Engl J Med. 2018;379(21):2040-2051. doi: 10.1056/NEJMoa1810865
- Gurrieri L, Mercatali L, Ibrahim T, et al. Immuno markers in newly diagnosed glioblastoma patients underwent Stupp protocol after neurosurgery: a retrospective series. J Neurooncol. 2023;164(1):55-64. doi: 10.1007/s11060-023-04357-9
- Viallard C, Larrivée B. Tumor angiogenesis and vascular normalization: alternative therapeutic targets. Angiogenesis. 2017;20(4):409-426. doi: 10.1007/s10456-017-9562-9
- Pan C, Liu H, Robins E, et al. Next-generation immuno-oncology agents: current momentum shifts in cancer immunotherapy. J Hematol Oncol. 2020;13(1):29. doi: 10.1186/s13045-020-00862-w
- Bourhis M, Palle J, Galy-Fauroux I, Terme M. Direct and Indirect Modulation of T Cells by VEGF-A Counteracted by Anti-Angiogenic Treatment. Front Immunol. 2021;12:616837. doi: 10.3389/fimmu.2021.616837
- Noman MZ, Desantis G, Janji B, et al. PD-L1 is a novel direct target of HIF-1α, and its blockade under hypoxia enhanced MDSC-mediated T cell activation. J Exp Med. 2014;211(5):781-790. doi: 10.1084/jem.20131916
- Wu FTH, Xu P, Chow A, et al. Pre- and post-operative anti-PD-L1 plus anti-angiogenic therapies in mouse breast or renal cancer models of micro- or macro-metastatic disease. Br J Cancer. 2019;120(2):196-206. doi: 10.1038/s41416-018-0297-1
- Schmittnaegel M, Rigamonti N, Kadioglu E, et al. Dual angiopoietin-2 and VEGFA inhibition elicits antitumor immunity that is enhanced by PD-1 checkpoint blockade. Sci Transl Med. 2017;9(385):eaak9670. doi: 10.1126/scitranslmed.aak9670
- Dong X, Ren J, Amoozgar Z, et al. Anti-VEGF therapy improves EGFR-vIII-CAR-T cell delivery and efficacy in syngeneic glioblastoma models in mice. J Immunother Cancer. 2023;11(3):e005583. doi: 10.1136/jitc-2022-005583
- Nayak L, Molinaro AM, Peters K, et al. Randomized Phase II and Biomarker Study of Pembrolizumab plus Bevacizumab versus Pembrolizumab Alone for Patients with Recurrent Glioblastoma. Clin Cancer Res. 2021;27(4):1048-1057. doi: 10.1158/1078-0432.CCR-20-2500
- Tsien CI, Pugh SL, Dicker AP, et al. NRG Oncology/RTOG1205: A Randomized Phase II Trial of Concurrent Bevacizumab and Reirradiation Versus Bevacizumab Alone as Treatment for Recurrent Glioblastoma. J Clin Oncol. 2023;41(6):1285-1295. doi: 10.1200/JCO.22.00164
- Park J, Skålhegg BS. Combination of PD-1/PD-L1 and CTLA-4 inhibitors in the treatment of cancer - a brief update. Front Immunol. 2025;16:1680838. doi: 10.3389/fimmu.2025.1680838
- Wu L, Mao L, Liu JF, et al. Blockade of TIGIT/CD155 Signaling Reverses T-cell Exhaustion and Enhances Antitumor Capability in Head and Neck Squamous Cell Carcinoma. Cancer Immunol Res. 2019;7(10):1700-1713. doi: 10.1158/2326-6066.CIR-18-0725
- Hung AL, Maxwell R, Theodros D, et al. TIGIT and PD-1 dual checkpoint blockade enhances antitumor immunity and survival in GBM. Oncoimmunology. 2018;7(8):e1466769. doi: 10.1080/2162402X.2018.1466769
- Zhu Y, An X, Zhang X, Qiao Y, Zheng T, Li X. STING: a master regulator in the cancer-immunity cycle. Mol Cancer. 2019;18(1):152. doi: 10.1186/s12943-019-1087-y
- Ahn J, Xia T, Rabasa Capote A, Betancourt D, Barber GN. Extrinsic Phagocyte-Dependent STING Signaling Dictates the Immunogenicity of Dying Cells. Cancer Cell. 2018;33(5):862-873.e5. doi: 10.1016/j.ccell.2018.03.027
- Awad RM, De Vlaeminck Y, Maebe J, Goyvaerts C, Breckpot K. Turn Back the TIMe: Targeting Tumor Infiltrating Myeloid Cells to Revert Cancer Progression. Front Immunol. 2018;9:1977. doi: 10.3389/fimmu.2018.01977
- Martins TA, Kaymak D, Tatari N, et al. Enhancing anti-EGFRvIII CAR T cell therapy against glioblastoma with a paracrine SIRPγ-derived CD47 blocker. Nat Commun. 2024;15(1):9718. doi: 10.1038/s41467-024-54129-w
- Inocencio JF, Mitrasinovic S, Asad M, Parney IF, Zang X, Himes BT. Immune checkpoint pathways in glioblastoma: a diverse and evolving landscape. Front Immunol. 2024;15:1424396. doi: 10.3389/fimmu.2024.1424396
- Qian D, Guo J, Duan Y, et al. Immunotherapeutic strategies targeting the PVR-TIGIT/CD96/CD226 signaling pathway in glioma treatment. Ann Med. 2025;57(1):2588717. doi: 10.1080/07853890.2025.2588717
- Cui H, Hamad M, Elkord E. TIGIT in cancer: from mechanism of action to promising immunotherapeutic strategies. Cell Death Dis. 2025;16(1):664. doi: 10.1038/s41419-025-07984-4
- Asad M, Inocencio J, Mitrasinovic S, et al. TIGIT expression dictates the immunosuppressive reprogramming of myeloid cells in glioblastoma. Neuro Oncol. 2026;28(6):1426-1441. doi: 10.1093/neuonc/noag044
- Lupo KB, Yao X, Borde S, et al. synNotch-programmed iPSC-derived NK cells usurp TIGIT and CD73 activities for glioblastoma therapy. Nat Commun. 2024;15(1):1909. doi: 10.1038/s41467-024-46343-3
- Vincze SR, Jaswal AP, Frederico SC, et al. ImmunoPET imaging of TIGIT in the glioma microenvironment. Sci Rep. 2024;14(1):5305. doi: 10.1038/s41598-024-55296-y
- Fujiwara K, Kitaura M, Tsunei A, Kusabuka H, Ogaki E, Okada N. Structure of the Signal Transduction Domain in Second-Generation CAR Regulates the Input Efficiency of CAR Signals. Int J Mol Sci. 2021;22(5):2476. doi: 10.3390/ijms22052476
- Hosseinkhani N, Derakhshani A, Kooshkaki O, et al. Immune Checkpoints and CAR-T Cells: The Pioneers in Future Cancer Therapies? Int J Mol Sci. 2020;21(21):8305. doi: 10.3390/ijms21218305
- Feldman L, Brown C, Badie B. Chimeric Antigen Receptor T-Cell Therapy: Updates in Glioblastoma Treatment. Neurosurgery. 2021;88(6):1056-1064. doi: 10.1093/neuros/nyaa584
- Shen L, Li H, Bin S, et al. The efficacy of third generation anti HER2 chimeric antigen receptor T cells in combination with PD1 blockade against malignant glioblastoma cells. Oncol Rep. 2019;42(4):1549-1557. doi: 10.3892/or.2019.7263
- Song P, Zhao X, Xiao S. Application prospect of peptide-modified nano targeting drug delivery system combined with PD-1/PD-L1 based immune checkpoint blockade in glioblastoma. Int J Pharm. 2020;589:119865. doi: 10.1016/j.ijpharm.2020.119865
- Wang K, Sun J, Zhao H, et al. Advances and Challenges in Nano-Delivery Systems for Glioblastoma Treatment: A Comprehensive Review. Int J Nanomedicine. 2025;20:9597-9620. doi: 10.2147/IJN.S531451
- Biau J, Durando X, Boux F, et al. NANO-GBM trial of AGuIX nanoparticles with radiotherapy and temozolomide in the treatment of newly diagnosed Glioblastoma: Phase 1b outcomes and MRI-based biodistribution. Clin Transl Radiat Oncol. 2024;48:100833. doi: 10.1016/j.ctro.2024.100833
- Wu C, Hormuth DA 2nd, Christenson CD, et al. Image-guided patient-specific optimization of catheter placement for convection-enhanced nanoparticle delivery in recurrent glioblastoma. Comput Biol Med. 2024;179:108889. doi: 10.1016/j.compbiomed.2024.108889
- Duan M, Cao R, Yang Y, et al. Blood-Brain Barrier Conquest in Glioblastoma Nanomedicine: Strategies, Clinical Advances, and Emerging Challenges. Cancers. 2024;16(19):3300. doi: 10.3390/cancers16193300
- Narsinh KH, Perez E, Haddad AF, et al. Strategies to Improve Drug Delivery Across the Blood-Brain Barrier for Glioblastoma. Curr Neurol Neurosci Rep. 2024;24(5):123-139. doi: 10.1007/s11910-024-01338-x
- Farooq M, Scalia G, Umana GE, et al. A Systematic Review of Nanomedicine in Glioblastoma Treatment: Clinical Efficacy, Safety, and Future Directions. Brain Sci. 2023;13(12):1727. doi: 10.3390/brainsci13121727
- Schalper KA, Rodriguez-Ruiz ME, Diez-Valle R, et al. Neoadjuvant nivolumab modifies the tumor immune microenvironment in resectable glioblastoma. Nat Med. 2019;25(3):470-476. doi: 10.1038/s41591-018-0339-5
- Ren CC, Xu B, Wang MS, et al. Meta-analysis of the correlation between glioma prognosis and PD-1/PD-L1 expression. Asian J Surg. 2023;46(12):5632-5634. doi: 10.1016/j.asjsur.2023.08.057
