Fibrotic response to anti-CSF-1R therapy potentiates glioblastoma recurrence.

Glioblastoma recurrence is currently inevitable despite extensive standard-of-care treatment. In preclinical studies, an alternative strategy of targeting tumor-associated macrophages and microglia through CSF-1R inhibition was previously found to regress established tumors and significantly increase overall survival. However, recurrences developed in ∼50% of mice in long-term studies, which were consistently associated with fibrotic scars. This fibrotic response is observed following multiple anti-glioma therapies in different preclinical models herein and in patient recurrence samples. Multi-omics analyses of the post-treatment tumor microenvironment identified fibrotic areas as pro-tumor survival niches that encapsulated surviving glioma cells, promoted dormancy, and inhibited immune surveillance. The fibrotic treatment response was mediated by perivascular-derived fibroblast-like cells via activation by transforming growth factor β (TGF-β) signaling and neuroinflammation. Concordantly, combinatorial inhibition of these pathways inhibited treatment-associated fibrosis, and significantly improved survival in preclinical trials of anti-colony-stimulating factor-1 receptor (CSF-1R) therapy.
Competing Interests: Declaration of interests A.Z. is a current employee of Genmab; D.C. received consulting fees from Seed Biosciences S.A. and is a current employee of Novigenix; S.N. is a current employee of Roche Pharmaceuticals; A.F.H. has served on advisory boards and speaker’s bureau for Novocure and Bayer; M.E.H. has an advisory role at TME Pharma; J.A.J. received a speaker honorarium from Bristol Meyers Squibb, and served on the scientific advisory board of Pionyr Immunotherapeutics; J.A.J. and D.H. serve on the Cancer Cell editorial advisory board.
(Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)