Reprogramming the vascular-immune niche: Towards a new therapeutic paradigm for glioblastoma

Glioblastoma (GBM) is a refractory and challenging malignant intracranial tumour due to its immunosuppressive microenvironment and vascular enrichment. Despite standard treatment and novel treatment modalities such as immunotherapy and the combination of medical and engineering technologies in therapy, the effectiveness of these methods remains limited, ultimately leading to unsatisfactory outcomes. Previous treatment strategies for glioma have focused mainly on tumour cells while neglecting the role of the tumour microenvironment (TME). Emerging immune, antiangiogenic, and targeted therapeutic strategies have shown promise in advancing the treatment of GBM. The immunosuppressive TME is involved in the accumulation of myeloid-derived suppressor cells, glioma-associated macrophages/microglia, regulatory T cells and immunosuppressive factors, fostering immune evasion. Moreover, the formation of abnormal blood vessels in GBM promotes the intratumoural infiltration of immunosuppressive cells. Therefore, the interaction between the immunosuppressive GBM microenvironment and neovascularisation facilitates tumour progression and recurrence. The aim of this review is to clarify the vascular-immune regulatory mechanisms embedded within the GBM microenvironment, investigate current antivascular and immunotherapy strategies, and identify potential therapeutic directions on the basis of vascular-immune crosstalk, ultimately improving the prognosis and quality of life for GBM patients.