Breaking immune isolation in glioblastoma

Glioblastoma (GBM) represents one of the prototypical immune-cold tumors, characterized by profound immune suppression, T-cell exclusion, low neoantigen burden, and a highly immunosuppressive myeloid-dominant tumor microenvironment (TME). Despite advances in immunotherapy, including immune checkpoint blockade (ICB), CAR-T cells, and cancer vaccines, clinical benefits remain limited. This review synthesizes emerging evidence on multi-modal strategies aimed at reprogramming the cold TME into an immunologically active state. We highlight innate immune agonists, oncolytic virotherapy, precision nanomedicine, metabolic modulation, and radiotherapy-immune synergies. We further propose an integrated framework combining spatial immunomics, targeted delivery technology, and TME-specific engineering to overcome the therapeutic bottlenecks of GBM.