Principal Challenges in the Adjuvant Treatment of Glioblastoma 2.0

Dear Colleagues,

In this decade, glioblastoma continues to be the most common malignant primary brain tumor in adults, being almost invariably incurable. Roughly 3 in 100 000 people develop this tumor each year. The course of the disease is characterized by a high symptom burden; early progression or recurrence; and, overall, a poor prognosis. New treatment strategies, such as immunotherapy, photodynamic therapy, and pharmacological combination therapy, are being developed to complement the mainstays of surgery, radiation, and traditional antineoplastic agents.

While the current standard of care remains maximally safe surgical resection followed by radiochemotherapy and adjuvant chemotherapy with temozolomide, alternating electrical fields have evolved as an additional option for early treatment. Despite these efforts, most patients experience tumor progression or recurrence within the first nine months after initial treatment. Second- and third-line therapies are usually less effective, and many research and treatment strategies have so far failed to break ground. Even though we increasingly document the geno- and phenotypic heterogeneity of glioblastoma, successful translation of this knowledge into better clinical outcomes is largely lacking.

Because biomarkers for disease monitoring have not yet entered clinical routine, the main pillar of disease monitoring is radiological imaging. The use of high-resolution magnetic resonance tomography and positron emission tomography potentially increased diagnostic and bioptic accuracy and enabled some correlation of imaging and molecular tumor characteristics. Despite this advancement, the differentiation of progression and pseudoprogression, an issue of high clinical relevance, remains challenging.

To delineate the borders of up-to-date glioblastoma research and treatment perspectives today, to define challenges and, even more so, formidable problems we are just beginning to understand, we invite innovative, high-profile, front-line basic researchers and clinical investigators in their respective areas to submit both original research and review articles on the following topics in glioblastoma:

(a) Progression versus pseudoprogression;
(b) Radiogenomics;
(c) The role of (re-) irradiation and radiosurgery;
(d) The potential of photodynamic therapy;
(e) The chances and limitations of immunotherapy;
(f) The chances and limitations of targeted therapy;
(g) Driver versus passenger gene mutations: What else can be learned from the cancer genome atlas? ;
(h) Bioinformatic approaches in target gene identification;
(i) The guidance of adjuvant personalized glioblastoma therapy by serial liquid biopsies — the potential of detecting circulating tumor DNA in plasma and cerebrospinal fluid;
(j) Adaptive clinical trials — are they delivering?

Prof. Marc-Eric Halatsch
Guest Editor
Dr. Tim Heiland
Co-Guest Editor

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