Emerging trends in cell-based therapies: contemporary advances and ethical considerations in translational neurosurgical oncology

Emerging cell-based therapies represent a promising advancement in neurosurgical oncology, offering novel therapeutic possibilities for challenging diagnoses such as high-grade gliomas. Traditional treatment modalities, including surgical resection, chemotherapy, and radiotherapy, offer limited efficacy due to the highly infiltrative nature and genomic heterogeneity of malignant brain tumors. The recent integration of molecular profiling and genotypic characterization into diagnostic and therapeutic frameworks underscores a significant evolution toward personalized medicine. Stem-cell-based approaches, notably neural and mesenchymal stem cells, demonstrate remarkable tropism for pathological tissues, providing innovative strategies for targeted therapeutic delivery and intrinsic anti-tumoral effects. Concurrently, immunotherapeutic advancements, particularly immune checkpoint inhibitors (ICIs), chimeric antigen receptor T-cell (CAR T-cell) therapies, and tumor vaccination techniques, have significantly altered therapeutic paradigms by leveraging patient-specific immune responses with minimal systemic toxicity. To contextualize such therapeutic innovations, we systematically reviewed and analyzed 28 ongoing glioblastoma clinical trials initiated since 2022 investigating cell-based strategies. This dataset elucidates key patterns in trial design, cellular targets, and combinatorial immunotherapeutic regimens. Despite the immense clinical promise, integrating cell-based and immunological therapeutics necessitates careful ethical deliberation and complex clinical management strategies, particularly when combined with conventional therapies. This review critically evaluates contemporary advancements, highlights emerging clinical trial outcomes, explores the ethical dimensions of novel therapeutics, and underscores the imperative for continued translational research to refine patient-specific therapeutic paradigms in neurosurgical oncology.