Evolving therapeutic strategies in glioblastoma: traditional approaches and novel interventions

Abstract Glioblastoma (GBM) is the most aggressive primary brain tumor in adults and is characterized by rapid growth, diffuse infiltration, and resistance to conventional therapies. This review explores pathophysiology, molecular mechanisms, and therapeutic advancements of GBM. GBM is highly heterogeneous and can be classified into molecular subtypes based on genetic and epigenetic alterations, influencing patient prognosis and treatment response. Despite advances in surgical techniques, chemotherapy, and radiotherapy, survival remains limited, with a median of 15–18 months. Emerging therapeutic strategies, including immunotherapy, tumor treatment, oncolytic virotherapy, and nanotechnology-based drug delivery, are under investigation to increase treatment efficacy. Immunotherapy, particularly checkpoint inhibitors and CAR-T-cell therapy, has potential but faces challenges due to the immunosuppressive microenvironment of GBM. Oncolytic viruses and personalized vaccines aim to trigger antitumor immune responses, whereas nanotechnology-based approaches enhance drug delivery across the blood‒brain barrier (BBB). This review highlights the urgent need for multimodal strategies that integrate novel therapies with existing standards to improve patient outcomes. Future research should focus on overcoming treatment resistance, leveraging molecular profiling for personalized medicine, and exploring innovative drug delivery systems.