Abikenari Matthew, Liu Justin, Ha Joseph H, Annagiri Shreyas, Himic Vratko, Medikonda Ravi, Kim Lily, Choi John, Lim Michael
Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA.
Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.
J Neurooncol. 2025 Jul 22. doi: 10.1007/s11060-025-05170-2.
Emerging cell-based therapies represent a promising advancement in neurosurgical oncology, offering novel therapeutic possibilities for challenging diagnoses such as high-grade gliomas. Traditional treatment modalities, including surgical resection, chemotherapy, and radiotherapy, offer limited efficacy due to the highly infiltrative nature and genomic heterogeneity of malignant brain tumors. The recent integration of molecular profiling and genotypic characterization into diagnostic and therapeutic frameworks underscores a significant evolution toward personalized medicine. Stem-cell-based approaches, notably neural and mesenchymal stem cells, demonstrate remarkable tropism for pathological tissues, providing innovative strategies for targeted therapeutic delivery and intrinsic anti-tumoral effects. Concurrently, immunotherapeutic advancements, particularly immune checkpoint inhibitors (ICIs), chimeric antigen receptor T-cell (CAR T-cell) therapies, and tumor vaccination techniques, have significantly altered therapeutic paradigms by leveraging patient-specific immune responses with minimal systemic toxicity. To contextualize such therapeutic innovations, we systematically reviewed and analyzed 28 ongoing glioblastoma clinical trials initiated since 2022 investigating cell-based strategies. This dataset elucidates key patterns in trial design, cellular targets, and combinatorial immunotherapeutic regimens. Despite the immense clinical promise, integrating cell-based and immunological therapeutics necessitates careful ethical deliberation and complex clinical management strategies, particularly when combined with conventional therapies. This review critically evaluates contemporary advancements, highlights emerging clinical trial outcomes, explores the ethical dimensions of novel therapeutics, and underscores the imperative for continued translational research to refine patient-specific therapeutic paradigms in neurosurgical oncology.
新兴的基于细胞的疗法是神经外科肿瘤学领域一项有前景的进展,为高级别胶质瘤等具有挑战性的诊断提供了新的治疗可能性。传统的治疗方式,包括手术切除、化疗和放疗,由于恶性脑肿瘤具有高度浸润性和基因组异质性,疗效有限。最近将分子谱分析和基因分型特征纳入诊断和治疗框架,凸显了向个性化医疗的重大转变。基于干细胞的方法,特别是神经干细胞和间充质干细胞,对病理组织表现出显著的趋向性,为靶向治疗递送和内在抗肿瘤作用提供了创新策略。同时,免疫治疗的进展,特别是免疫检查点抑制剂(ICIs)、嵌合抗原受体T细胞(CAR T细胞)疗法和肿瘤疫苗技术,通过利用患者特异性免疫反应且全身毒性最小,显著改变了治疗模式。为了将这些治疗创新置于背景中,我们系统地回顾和分析了自2022年以来启动的28项正在进行的胶质母细胞瘤临床试验,这些试验研究基于细胞的策略。该数据集阐明了试验设计、细胞靶点和联合免疫治疗方案中的关键模式。尽管具有巨大的临床前景,但整合基于细胞的疗法和免疫疗法需要仔细的伦理考量和复杂的临床管理策略,特别是与传统疗法联合使用时。本综述批判性地评估了当代进展,突出了新兴的临床试验结果,探讨了新型疗法的伦理层面,并强调了持续进行转化研究以完善神经外科肿瘤学中患者特异性治疗模式的必要性。