HMN 2025: How Combination therapy shows promise for overcoming treatment resistance in glioblastoma

Research spotlight: Combination therapy shows promise for overcoming treatment resistance in glioblastoma
Mechanisms of response and resistance to Wnt inhibition and ?PD1 in GBM. Response to WNT974 and ?PD1 is likely mediated by an expansion of DC3-like DCs capable of antigen presentation, reduction in gMDSCs and associated immune suppression, and increased ratio of proliferative CD8/Treg. This is accompanied by an increase in mMDSCs as a mode of resistance. Resistance to WNT974 and ?PD1 is also likely mediated by pro-oncogenic pathways such as mTOR and MAPK/ERK that could activate ?-catenin and sustain downstream Wnt signaling. (Figure created in BioRender). Credit: Proceedings of the National Academy of Sciences (2025). DOI: 10.1073/pnas.2414941122

Rakesh Jain, Ph.D., director of the Edwin Steele Laboratories for Tumor Biology in the Department of Radiation Oncology at Massachusetts General Hospital and Andrew Werk Professor of Radiation Oncology at Harvard Medical School, is senior and corresponding author of a new paper in Proceedings of the National Academy of Sciences, “Wnt Inhibition Alleviates Resistance to Anti-PD1 Therapy and Improves Anti-Tumor Immunity in Glioblastoma.”

How would you summarize your study for a lay audience?

Brain tumor patients with glioblastoma (GBM) face extremely limited treatment options and show poor responses to current immunotherapies. New treatment strategies are desperately needed.

Wnt signaling is a crucial cell communication process that regulates various aspects of stem cell behavior. It is also pivotal in the generation of GBM and contributes to treatment resistance.

In this new study, we identify Wnt7b, which is highly expressed in GBM patients, as a previously unknown determinant of resistance to immune checkpoint blockers.

Our findings reveal that targeting the Wnt7b/?-catenin pathway can sensitize stem-cell rich GBM to immune checkpoint blockade, offering a promising new therapeutic avenue.

We also demonstrate the potential of a porcupine inhibitor, WNT974, which has been shown to be safe in a phase I trial in patients with extracranial tumors, to synergize with anti-PD1 therapy by alleviating immunosuppressive mechanisms and enhancing anti-tumor immunity.

These results support the rationale for personalized of combination WNT974/anti-PD1 therapy in glioblastoma patients with elevated Wnt7b/?-catenin signaling, aiming to overcome resistance to immunotherapy.

What question were you investigating?

Glioblastoma (GBM) is a deadly brain cancer. Current treatments, including a type of immunotherapy called anti-PD1, don’t work well for most patients. We are trying to figure out why—and how to fix it.

What methods or approach did you use?

We found that a molecule called Wnt7b is very active in GBM tumors. This molecule seems to help cancer suppress the immune system, making treatments like anti-PD1 less effective.

We tested a drug called WNT974, which blocks Wnt signaling, as a combination therapy along with anti-PD1 immune checkpoint therapy.

What did you find?

When we gave this drug to mouse models of GBM alongside anti-PD1 therapy, the results were promising—the tumors shrank, the mice lived longer, and some mice did not develop tumors again.

A closer look revealed that the was effective in:

  • Waking up the immune system by helping special cells (called ) make the tumor more visible
  • Boosting killer T cells that attack the tumor
  • Reducing suppressor cells that normally protect the tumor from immune attack

What are the implications?

GBM patients face extremely limited treatment options and poor responses to current immunotherapies. Our findings reveal that targeting the Wnt7b/?-catenin pathway can sensitize stem-cell rich GBM to immune checkpoint blockade, offering a promising new therapeutic avenue.

What are the next steps?

These results support the rationale for personalized clinical trials in glioblastoma patients with elevated Wnt7b/?-catenin signaling, aiming to overcome resistance to immunotherapy.

More information:
Shanmugarajan Krishnan et al, Wnt inhibition alleviates resistance to anti-PD1 therapy and improves antitumor immunity in glioblastoma, Proceedings of the National Academy of Sciences (2025). DOI: 10.1073/pnas.2414941122


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