Current Status and Evolution of Immunotherapy in Glioma Management

Gliomas, especially glioblastoma (GBM), are the most aggressive primary brain tumors, and their treatment faces multiple challenges. These challenges include incomplete surgical resection, the blood-brain barrier (BBB) that limits drug delivery, and an immunosuppressive tumor microenvironment (TME). Despite the "cold tumor" nature of gliomas, significant progress has been made in immunotherapy strategies. In this review, we focus on the following four strategies: 1) Cancer vaccines, especially personalized vaccines based on neoantigens, can activate specific immune responses; 2) Immune checkpoint inhibitors (ICIs) to reverse T cell exhaustion (e.g., anti-PD-1/PD-L1 antibodies); 3) Adoptive immune cell therapies, particularly chimeric antigen receptor T-cell (CAR-T) therapy, have shown encouraging results in preclinical trials; 4) Oncolytic viruses, which have dual roles of directly lysing tumor cells and stimulating immune responses. Immunotherapy offers a new paradigm to overcome the limitations of conventional glioma therapy. However, tumor heterogeneity, BBB limitation, target selection, and immunosuppressive microenvironment remain major obstacles. Future research should focus on developing combination therapies such as immunotherapy combined with radiotherapy, targeted therapy, exploring novel targets, and using biomarkers for patient stratification, which may help improve the survival outcomes of glioma patients. This review comprehensively evaluates the latest clinical progress of glioma immunotherapy, assesses the current limitations, and explores future directions.