2026 Poster Presentations
P001: SURGERY-ANCHORED IMMUNOTHERAPY FOR GLIOBLASTOMA: EXTENT OF RESECTION AS A DETERMINANT OF BENEFIT WITH DENDRITIC CELL VACCINES AND ADOPTIVE CELLS
Eric M Kunz, BS1; Devon T Foster, BS1; Abdullah Durrani, BS1; Ivelina P Kioutchoukova, BS2; Rajvi Thakkar, BS2; Caroline Davidson, BS2; Marco Foreman, BS2; Brandon Lucke-Wold, MD, PhD3; 1Florida International University - Herbert Wertheim College of Medicine; 2University of Florida College of Medicine; 3University of Florida - Department of Neurosurgery
Phase II/III evidence on active immunotherapies for glioblastoma (GBM) was synthesized, focusing on dendritic cell (DC) vaccines and adoptive cellular approaches, versus contemporary standard therapy, and to identify effect modifiers (MGMT status, extent of resection, and corticosteroids) that should guide surgical and adjuvant decision-making. Following PRISMA methods, a systematic review of PubMed, Embase, and Cochrane (2020–2025) for adult GBM trials with a comparator arm was conducted. Outcomes included overall survival (OS), progression-free survival (PFS), safety, and prespecified modifiers. Of 797 records, 13 trials met criteria (9 newly diagnosed, 3 recurrent, 1 mixed). Among active immunotherapies, DC vaccines and adoptive cell therapies showed the most consistent clinical signals. DCVax-L improved median OS versus external controls in newly diagnosed GBM (19.3 vs 16.5 months; 5-year OS 13.0% vs 5.7%). Cytokine-induced killer (CIK) cells prolonged PFS and were an independent predictor of longer OS in pathologically pure GBM (median OS 23.1 vs 14.9 months; PFS 8.1 vs 5.5 months). In contrast, adding PD-1/CTLA-4 inhibition to chemoradiation failed to improve first-line OS/PFS, and at recurrence, bevacizumab outperformed nivolumab for PFS with similar OS; pembrolizumab plus bevacizumab improved 6-month PFS versus pembrolizumab alone. Grade 3 or higher adverse events ranged from approximately 15% to 52% across interventions and were generally manageable. Baseline corticosteroid exposure consistently attenuated the benefit of immunotherapy; maximal safe resection correlated with better outcomes and larger apparent effects of vaccines/adoptive cells. MGMT status displayed modality-specific interactions (i.e., DCVax-L benefit in MGMT-methylated disease; interferon-α signal in unmethylated disease). Evidence supports a surgery-anchored, steroid-sparing pathway in which active immunotherapies, particularly DC vaccines and adoptive cellular strategies, are integrated as adjuncts to standard chemoradiotherapy, while routine upfront checkpoint blockade is not currently justified. Future trials should prospectively stratify by MGMT status and extent of resection, minimize corticosteroids, and test rational combinations that leverage low residual disease after surgery. We translate these findings into a pragmatic clinical algorithm to assist neurosurgical decision-making from diagnosis through recurrence.
