Introduction
tumor, Glioblastoma, tumors
TUMOR, RECURRENCE, MALIGNANT BRAIN TUMOR, DISEASE, GLIOBLASTOMA, RECURRENT DISEASE, TUMORS
Glioblastoma (GBM), the most frequent malignant brain tumor in adults, is a devastating disease with a median survival of 14.6 months for patients treated with standard radiotherapy and chemotherapy and reaching a median of 21.7 months when selecting patients whose tumors have epigenetic silencing of the O6-methylguanine-DNA methyltransferase (MGMT) DNA repair gene by promoter methylation (The disease invariably recurs. There is no first-line treatment for recurrent disease, and patients are left with the option of a clinical trial if available or the physician's best choice for a particular patient. Studies utilizing lomustine chemotherapy combined with bevacizumab versus lomustine alone at first recurrence reported an improvement of progression-free survival (PFS) of 4.2 versus 1.5 months, but no survival advantage for the combination with a median overall survival (OS) of 9.1 versus 8.6 months for lomustine alone (The use of immune checkpoint inhibition (ICI), which removes T-cell activation inhibitory signals, unleashing T cells to eradicate tumor cells, has been groundbreaking (Nevertheless, intratumor and immune landscape heterogeneity may benefit the treatment of GBM with ICI (