Combination Therapies for Brain Tumors

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Therapy".

Deadline for manuscript submissions: 31 October 2025 | Viewed by 4078

Special Issue Editors


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Guest Editor
Department of Neurosurgery and Neuroscience Institute, Baylor Scott & White Health, Temple, TX 76508, USA
Interests: neurological surgery; nervous system injury and repair; brain tumor

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Guest Editor
Department of Neurology, Medical College of Wisconsin 8701 Watertown Plank, Milwaukee, WI 53226, USA
Interests: neuro-genomics (rare neurological disorders and complex traits); pharmacogenomics (efficacy, toxicity/ADR and PK/metabolism of neurology and neuro-oncology drugs); brain tumor registry and biobanking; translational neurology-oncology (therapeutic target validation and clinical trials)

Special Issue Information

Dear Colleagues,

Combination therapies for brain tumors represent a promising and multifaceted approach in the ongoing battle against this devastating disease. The complexity and heterogeneity of brain tumors pose significant challenges for single-modality treatments. However, by strategically combining different therapeutic strategies, such as surgery, radiation therapy, chemotherapy, targeted therapies and immunotherapy, researchers and clinicians can effectively target multiple aspects of tumor growth and progression.

Surgery remains a cornerstone in brain tumor treatment, providing maximal tumor resection and alleviating mass effects. Following surgery, radiation therapy can be employed to target residual tumor cells and prevent recurrence, while chemotherapy may be utilized to eradicate systemic metastases and infiltrative tumor cells beyond the surgical field. Emerging targeted therapies, focusing on specific molecular alterations in tumor cells, offer personalized treatment options and minimize off-target effects. Additionally, immunotherapies aim to harness the body's immune system to recognize and destroy tumor cells, showing great promise in several types of brain tumors.

By integrating these diverse treatment modalities, clinicians can achieve synergistic effects and significantly improve patient outcomes. Moreover, such tailored approaches consider the unique characteristics of each patient's tumor, optimizing therapeutic responses. As research advances, combination therapies hold tremendous potential to transform the landscape of brain tumor management, offering hope for increased survival rates and enhanced quality of life for patients and their families.

With this Special Issue, we aim to curate the most recent, innovative and ground-breaking research on brain tumors, encompassing glioblastomas, metastatic brain tumors and low-grade gliomas, while covering surgical, clinical and bio-molecular advances. The ultimate goal is to promote novel and effective treatments for this deadly disease. Therefore, we warmly welcome contributions from surgeons, radiation oncologists, neuro-oncologists, pathologists, molecular biologists and all professionals involved in high-grade glioma research. Together, we can drive progress and bring new hope to those affected by brain tumors.

Dr. Jason H. Huang
Dr. Ekokobe Fonkem
Guest Editors

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Keywords

  • novel diagnostics
  • therapies
  • glioblastoma
  • meningioma
  • astrocytoma

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Published Papers (4 papers)

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Review

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21 pages, 952 KiB  
Review
Tumor Treating Fields and Combination Therapy in Management of Brain Oncology
by Ruisi Nicole Liu, James H. Huang, Xiaoming Qi, Yizhong Pan, Erxi Wu and Damir Nizamutdinov
Cancers 2025, 17(7), 1211; https://doi.org/10.3390/cancers17071211 - 2 Apr 2025
Viewed by 677
Abstract
Glioblastoma (GBM) remains a challenging cancer to treat with limited effective therapies. Standard treatments, including surgery, radiotherapy, chemotherapy, targeted therapy, and immunotherapy, offer marginal survival benefits but are often limited by side effects and drug resistance. Temozolomide is the most commonly used chemotherapy; [...] Read more.
Glioblastoma (GBM) remains a challenging cancer to treat with limited effective therapies. Standard treatments, including surgery, radiotherapy, chemotherapy, targeted therapy, and immunotherapy, offer marginal survival benefits but are often limited by side effects and drug resistance. Temozolomide is the most commonly used chemotherapy; however, resistance and lack of efficacy in recurrent GBM hinder its success. Tumor treating fields (TTFields), a novel non-invasive modality that utilizes alternating electric fields, have recently emerged as a promising treatment for GBM. TTFields work by disrupting the function of the mitotic spindle and inducing apoptosis in cancer cells. They can be especially effective when combined with other therapies. TTFields enhance drug delivery when paired with chemotherapy by increasing the permeability of the blood–brain barrier and cell membranes, leading to more effective tumor inhibition. Similarly, TTFields increase cancer cell sensitivity to radiation therapy and improve the efficacy of targeted therapies, such as sorafenib and immunotherapy, particularly in extra-cranial tumors. The Optune device, the primary medical device for TTFields’ delivery, offers a convenient and versatile treatment option, allowing remote care and exhibiting fewer adverse effects. This review discusses the potential of TTFields as a valuable addition to GBM treatment, particularly in combination therapies, and highlights the device’s clinical applications. Full article
(This article belongs to the Special Issue Combination Therapies for Brain Tumors)
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20 pages, 4053 KiB  
Review
Pericytes in Glioblastoma: Hidden Regulators of Tumor Vasculature and Therapy Resistance
by Irene Salazar-Saura, María Pinilla-Sala, Javier Megías, Lara Navarro, Esther Roselló-Sastre and Teresa San-Miguel
Cancers 2025, 17(1), 15; https://doi.org/10.3390/cancers17010015 - 24 Dec 2024
Cited by 1 | Viewed by 1206
Abstract
Glioblastoma IDH wild type (GB), the most common malignant primary brain tumor, is characterized by rapid proliferation, extensive infiltration into surrounding brain tissue, and significant resistance to current therapies. Median survival is only 15 months despite extensive clinical efforts. The tumor microenvironment (TME) [...] Read more.
Glioblastoma IDH wild type (GB), the most common malignant primary brain tumor, is characterized by rapid proliferation, extensive infiltration into surrounding brain tissue, and significant resistance to current therapies. Median survival is only 15 months despite extensive clinical efforts. The tumor microenvironment (TME) in GB is highly specialized, supporting the tumor’s aggressive behavior and its ability to evade conventional treatments. One critical component is the aberrant vascular network that complicates the delivery of chemotherapy across the blood–brain barrier. Antiangiogenic therapies emerged as a promising option but have shown limited efficacy in extending the survival of these patients. Comprehension of the complex vascular network of GB may be a key to overcoming the limitations of current therapies. Pericytes are gaining recognition within the context of the TME. These mural cells are essential for vascular integrity and may contribute to tumor progression and therapeutic resistance. Although their role has been evidenced in other tumors, they remain underexplored in GB. Pericytes are known to respond to tumor hypoxia and interact with vascular endothelia, influencing responses to DNA damage and antiangiogenic treatments. They actively regulate not only angiogenesis but also the different vasculogenic strategies for tumor neovascularization. Additionally, they affect leukocyte trafficking and tumor-associated macrophages. This review aims to integrate the various functions controlled by pericytes to favor deeper investigation into their actionable potential. Pericytes may represent a promising target for novel therapeutic strategies in order to improve patient outcomes. Full article
(This article belongs to the Special Issue Combination Therapies for Brain Tumors)
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Other

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17 pages, 730 KiB  
Systematic Review
Nutritional Assessment and Management of Patients with Brain Neoplasms Undergoing Neurosurgery: A Systematic Review
by Jose Carlos Pebes Vega, Stefano Mancin, Giulia Vinciguerra, Elena Azzolini, Francesco Colotta, Manuela Pastore, Sara Morales Palomares, Diego Lopane, Giovanni Cangelosi, Simone Cosmai, Daniela Cattani, Riccardo Caccialanza, Emanuele Cereda and Beatrice Mazzoleni
Cancers 2025, 17(5), 764; https://doi.org/10.3390/cancers17050764 - 24 Feb 2025
Cited by 1 | Viewed by 554
Abstract
Background/Aim: Nutritional management in neurosurgical patients with brain neoplasms is critical, as optimal nutritional status is potentially associated with improved clinical outcomes. This systematic review aimed to analyze the impact of pre- and postoperative nutritional assessment and effect of prepost interventions on the [...] Read more.
Background/Aim: Nutritional management in neurosurgical patients with brain neoplasms is critical, as optimal nutritional status is potentially associated with improved clinical outcomes. This systematic review aimed to analyze the impact of pre- and postoperative nutritional assessment and effect of prepost interventions on the clinical outcomes. Methods: A systematic review was conducted using the PubMed, Cochrane Library, Embase, and CINAHL databases, complemented by a search of grey literature. Study quality was assessed using the Joanna Briggs Institute framework, and the certainty of evidence was graded according to the Oxford Centre for Evidence-Based Medicine levels. Results: Fourteen studies, encompassing a total of 11,224 adult patients with brain neoplasms, were included. Many of these studies were retrospective, had small sample sizes, and examined diverse nutritional protocols. Preoperative nutritional status assessment, including clinical parameters such as albumin (p < 0.001), Controlling Nutritional Status score (p = 0.001), and Prognostic Nutritional Index (p < 0.010), combined with postoperative oral nutritional supplements (p < 0.001), was significantly associated with postoperative clinical outcomes. Additionally, personalized nutritional counseling contributed to a reduction in complications and facilitated more effective functional recovery. Conclusions: Nutritional care is vital in managing neurosurgical patients with brain neoplasms, reducing complications and enhancing postoperative recovery and overall clinical outcomes. A multidisciplinary team is key to optimal outcomes. Future research should aim to standardize protocols for broader applicability. Full article
(This article belongs to the Special Issue Combination Therapies for Brain Tumors)
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15 pages, 452 KiB  
Systematic Review
Primary Extradural Meningioma: A Systematic Review of Diagnostic Features, Clinical Management, and Surgical Outcomes
by Kishore Balasubramanian, Jeffrey A. Zuccato, Abdurrahman F. Kharbat, Christopher Janssen, Nancy M. Gonzalez and Ian F. Dunn
Cancers 2024, 16(23), 3915; https://doi.org/10.3390/cancers16233915 - 22 Nov 2024
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Abstract
Objective: This systematic review consolidates the literature on primary extradural meningiomas (PEMs), a rare subset of meningiomas. We describe the clinical features, management strategies used, and treatment outcomes for published cases. Methods: A systematic review was conducted using PRISMA guidelines across multiple databases [...] Read more.
Objective: This systematic review consolidates the literature on primary extradural meningiomas (PEMs), a rare subset of meningiomas. We describe the clinical features, management strategies used, and treatment outcomes for published cases. Methods: A systematic review was conducted using PRISMA guidelines across multiple databases to 29 July 2024. Inclusion criteria were adult patients with primarily extradural meningioma and where individual patient clinical data were provided. Results: Of 216 studies that met the initial search criteria, 41 satisfied the final inclusion criteria. These 41 studies included 82 patients with 84 total PEMs. The cohort was balanced between sexes with a median age of 46 (range 18–82). Frequent symptoms at initial presentation included pain/headache (46%), weakness (44%), paresthesias (24%), and a palpable superficial mass (23%). The median duration of symptoms to diagnosis was 11 months (range 0.75–120). Surgical resection was the primary treatment approach, achieving a gross total resection in 67% of cases. The majority of lesions were classified as WHO grade 1 (87%). A recurrence was identified during the published follow-up in 11% of cases and a higher WHO grade was expectedly associated with a greater risk of recurrence. The described practice was to use adjuvant radiotherapy in recurrent and high-grade cases. Most cranial lesions were located in the frontal bone, while most spinal lesions affected the cervical spine. Post-treatment symptom improvement or resolution was described in almost all patients at the last follow-up. Conclusions: In comparison to intradural meningiomas, PEMs largely follow a more indolent course with a longer duration of symptoms prior to diagnosis, more benign symptoms, a higher proportion of grade 1 tumors, and favorable outcomes; however, there is a small subset of PEMs with extension outside the cranium and spine that require specific considerations for management. Full article
(This article belongs to the Special Issue Combination Therapies for Brain Tumors)
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