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increased amount of proinflammatory cytokines along with aberrant infiltration of stimulated T cells into
normal tissues [99,100] . Nevertheless, there is a lot of room for further improvement and immune checkpoint
blockade may serve as a viable immunotherapeutic strategy for patients with GB.

FUTURE DIRECTIONS
Immunotherapy for GB is being thoroughly investigated in a plethora of studies to establish the safety and
efficacy for therapeutic exploitation. Results of critical studies are eagerly awaited before decision making for
integration of immunotherapy into clinical practice of GB management. A few points to be considered for
GB immunotherapy are as follows:
-Further investigation and understanding of the immune system evasion mechanisms may assist in
improved therapeutic exploitation of personalized immunotherapeutic strategies for GB patients. Focusing
on molecular subtypes of GB and identification of molecular factors affecting the interplay between the
tumor and immune system may be critical for developing personalized treatments for patients suffering
from this deadly disease.
-Measurement of immune response may be further optimized through the introduction of standardized and
validated assays, which play a central role in therapeutic decision making for a given immunotherapeutic.
-Given the grim prognosis of GB patients, current standard management may be judiciously supported
by boosting of antitumor response with immunotherapy. In this context, achieving an improved
therapeutic ratio for GB patients may warrant the utilization of combination therapies with incorporation
of immunotherapeutic approaches to exploit the advantage of synergistic antitumor activity of multiple
treatment modalities.

Clearly, well-designed clinical trials are needed to assess efficacy and safety of combined modality GB
management using immunotherapeutic agents. Improved understanding of the interactions between
chemotherapy, radiotherapy and immunotherapeutic strategies will shed light on further research for
optimization of more potent treatment of GB patients.

CONCLUSION
Recent years have witnessed unprecedented advances and breakthroughs in basic and translational cancer
research, leading to significant improvements in therapeutic outcomes for several tumors. Utilization of
immunotherapeutic strategies proved to be efficacious against several cancers, leading to their thorough
investigation for management of GB patients. Immunotherapy of GB has yet resulted in mixed success with
conflicting research findings, emphasizing the need for extensive study before its integration into routine
clinical practice. Although there is a lot of room for improvement, immunotherapy for GB may be feasible
and serve as a viable management strategy broadening and strengthening the therapeutic armamentarium
to combat this deadly disease.

DECLARATIONS
Authors’ contributions
Concept and design of study: Sager O, Dincoglan F, Dirican B, Beyzadeoglu M
Drafting the article: all authors
Revising the aticle critically for important intellectual content: Sager O, Dirican B, Beyzadeoglu M
Final approval of the version to be published: all authors

Availability of data and materials
Not applicable.