Glioblastoma

Glioblastoma (GBM), historically termed glioblastoma multiforme, is an aggressive primary malignant tumor of the central nervous system and the most advanced diffuse astrocytic glioma in the adult-type classification. In current World Health Organization terminology, many tumors formerly grouped as glioblastoma are classified as glioblastoma, IDH-wildtype, CNS WHO grade 4. The disease is characterized by rapid and infiltrative growth, marked cellular and molecular heterogeneity, necrosis and microvascular proliferation, and invasion of surrounding brain tissue. These features complicate complete surgical resection and contribute to recurrence.

GBM biology is shaped by interactions among malignant cells, the tumor microenvironment, macrophages, microglia, blood vessels, and signaling pathways involving EGFR, transforming growth factor, and other regulatory networks. The blood–brain barrier limits delivery of many chemotherapy and targeted agents, including doxorubicin and some experimental therapeutics. Standard therapy generally combines maximal safe surgical resection with radiation therapy and temozolomide, although treatment response and prognosis vary with age, functional status, tumor location, molecular characteristics, and biomarkers such as O-6-methylguanine-DNA methyltransferase. At recurrence, treatment may include additional surgery, systemic chemotherapy, bevacizumab, radiation therapy in selected circumstances, experimental checkpoint inhibitor or CAR-T-cell approaches, and other clinical-trial strategies. Despite multimodal treatment, glioblastoma commonly recurs, and progression-free survival and overall survival remain limited.