April 16, 2026
While immunotherapy has been a remarkable success in the treatment of several tumor types, establishing its effectiveness in the central nervous system (CNS) tumor space has been challenging, particularly for glioblastoma (GBM) patients. Several factors are thought to contribute to this lack of progress including the blood-brain barrier limiting penetration of systemic therapies, tumor heterogeneity, relative lymphopenia, and local immune suppression, and immunosuppressive therapies (e.g. steroids, radiation, and chemotherapy) that are currently the standard of care.
However, ongoing research suggests that there may be a role for neoadjuvant immunotherapy in this setting.
“If you remove all the tumor and then give the immunotherapy, there will be less material to educate the immunotherapy to attack the cancer,” Dr. Mustafa Khasraw, a neuro-oncologist and physician scientist at Duke University, tells SurvivorNet Connect. “Based on that observation, that has proven true in diseases like melanoma, we are conducting clinical trials in newly diagnosed patients who have not received any therapy … now, we want to capture these patients before the surgeon has touched them.”
The idea, Dr. Khasraw adds, is that when the tumor is still present, the immunotherapy is more likely to work. This is the thought process behind the GIANT Trial. One of the first prospective trials looking at giving immunotherapy in the upfront setting.
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