Targeting Metabolic Vulnerabilities in Glioblastoma: a Framework for Multi-node Combination Therapy

PURPOSE OF REVIEW: While glioblastoma (GBM) exhibits a poor prognosis despite standard therapy, targeted metabolic therapy is promising as adjuvant therapy. The purpose of this review is to delineate the rationale behind metabolic therapy, the bypass mechanisms conferring resistance to each therapy, and potential synergistic combination strategies. RECENT FINDINGS: Critical enzymes in glycolysis, glutaminolysis, lipid metabolism, nucleotide synthesis, and mitochondrial metabolism are promising individual targets of metabolic therapy and lead to cell death in preclinical studies. However, with metabolic monotherapy, GBM cells can rely on other isoforms or switch to alternative pathways for energy production and biosynthesis. Preclinical studies show that targeting multiple metabolic nodes with combination therapy blocks these resistance pathways and synergistically inhibits tumor growth. While metabolic monotherapies exhibit limited success, synergistic combination therapies may bypass resistance mechanisms and are more promising. Combination therapies delivered with standard of care may improve patient outcomes, and larger clinical trials are needed to establish the use of combination regimens to improve overall survival.