Dendritic cell therapy is an emerging treatment approach for glioblastoma and selected high-grade gliomas. It uses patient immune cells and tumor-related material to stimulate an immune response against cancer cells. Eligibility depends on diagnosis, previous treatment, tumor tissue, disease status and overall condition. Clinical studies, including DCVax-L, have reported encouraging findings, while specialist assessment and access in Germany vary by programme.

Dendritic Cell Therapy for Glioblastoma and High-Grade Gliomas in Germany

Patients and families researching glioblastoma may come across dendritic cell therapy and want to understand where it fits in treatment and whether it may be suitable for them. Clinical studies have reported encouraging findings, and dendritic cell therapy in Germany may be considered for selected patients as an additional treatment approach alongside established therapies. 

The Role of Dendritic Cell Therapy in Brain Cancer

Glioblastoma can suppress the immune response, making it harder for immune cells to recognise and attack the tumor. Dendritic cell vaccination aims to stimulate an immune response against tumor cells. This differs from chemotherapy and radiotherapy, which act more directly against cancer cells although both conventional treatments can also influence the immune response. Most clinical evidence is in glioblastoma, where outcomes remain limited despite standard treatment and surgery may provide tumor tissue for vaccine preparation. Research has also included other high-grade gliomas, including astrocytoma, IDH-mutant, CNS WHO grade 4, but the evidence in these groups is more limited [4].

Dendritic cell vaccines vary between programmes. Differences include the tumor antigens used, how the cells are prepared, whether the cells come from the patient or a donor, the number of doses and other treatments given alongside the vaccine. Results from one programme therefore cannot automatically be applied to another. Dendritic cell therapy has mainly been studied as an addition to standard treatment rather than as a replacement. In newly diagnosed glioblastoma, it may be used after surgery and alongside or after radiotherapy and temozolomide [1].

Eligibility and Patient Selection for Dendritic Cell Therapy

A diagnosis of glioblastoma does not automatically mean that a patient is suitable for dendritic cell therapy.

Eligibility is assessed individually and may depend on:

• Whether the disease is newly diagnosed or recurrent.
• Previous surgery and whether suitable tumor tissue was collected and stored.
• Previous radiotherapy and drug treatment.
• Current tumor status on MRI and the patient’s clinical condition.
• General health and ability to complete treatment.
• Ability to undergo blood-cell collection where required.
• Conditions or medicines that suppress the immune system, including high-dose corticosteroids.

Some dendritic cell vaccine approaches require suitable tumor tissue collected during surgery. Patients who have had only a biopsy may have less tissue available because stereotactic biopsy is designed mainly to obtain enough tissue for diagnosis [6]. Eligibility criteria vary between programmes because vaccine methods, treatment schedules and patient-selection requirements differ. A patient who is not eligible for one programme may therefore meet the criteria for another.

How Dendritic Cell Vaccines Are Prepared

Dendritic cell vaccines are personalised biological treatments that require several laboratory steps before administration.

The process usually includes:

• Cell collection: Immune cells are collected from the patient’s blood. These cells are then separated and prepared for vaccine production.
• Laboratory culture: The collected cells are developed into dendritic cells and matured over several days under controlled laboratory conditions.
• Antigen loading: The dendritic cells are exposed to tumor-related material so they can present tumor antigens to the immune system. Some programmes use a preparation made from the patient’s own tumor tissue, known as tumor lysate, while others use selected tumor antigens, peptides or material from established tumor cell lines.
• Quality control and release: The prepared vaccine is tested to confirm that it meets the required quality standards before it is given to the patient.

The number of vaccine doses that can be produced varies between manufacturing methods [3] [4]. Vaccine manufacture may take several weeks.

Dendritic Cell Therapy Process, Combination and Follow-Up

Before treatment, specialists review the pathology and molecular findings, MRI scans and previous treatment history. Once the vaccine has been prepared, it is usually given by injection at intervals determined by the treatment programme. Patients are monitored during and after treatment with clinical reviews, MRI scans and, where appropriate, blood tests. Follow-up also assesses treatment tolerance and changes in disease status. The number of doses and treatment schedule vary between programmes.

In clinical studies, dendritic cell vaccines have been used:

• After surgery.
• Alongside or after radiotherapy and temozolomide in newly diagnosed disease  [3].
  
• After completion of chemoradiation.
• In recurrent disease, sometimes alongside other treatments.
• With other immune-based treatments, although these combinations remain at an early stage of research.

Previous and planned treatments can affect vaccine timing. Chemotherapy may lower blood-cell counts, while corticosteroids can suppress immune activity. Both may influence when cells are collected and when vaccination can be given.

Results, Evidence and Clinical Status of Dendritic Cell Therapy

The largest published study evaluated DCVax-L, a personalised vaccine made using the patient’s own dendritic cells and tumor material. The phase 3 study included 331 patients at 94 sites in four countries, including Germany. Among 232 patients with newly diagnosed glioblastoma who received the vaccine, median overall survival was 19.3 months from randomisation, compared with 16.5 months in an external control group. Among 64 patients treated after recurrence, median survival was 13.2 months compared with 7.8 months in external controls [2].

Median overall survival reported in the DCVax-L phase 3 study compared with external control groups [2]. These comparisons were not randomised.

These results require careful interpretation. Because most participants eventually received the vaccine, survival was compared with external control patients from other clinical trials rather than with a randomized placebo group. Differences between the study population and external controls may have influenced the results. Smaller phase I and II studies have shown that dendritic cell vaccines can be manufactured and are generally well tolerated. Some studies have reported encouraging overall survival, progression-free survival or disease-control outcomes, although results vary between vaccine approaches and patient groups. Study designs also differ considerably, and strong randomized evidence remains limited [3] [4] [5].

Clinical evidence and regulatory approval are separate. Publication of study results does not mean that a treatment has been approved for routine use. Regulatory status may differ between countries and individual treatment programmes.

Safety and Limitations of Dendritic Cell Therapy

Dendritic cell vaccination has generally been well tolerated in published studies, with most reported side effects being mild or moderate; however, safety varies between vaccine platforms and treatment protocols, and adverse events have also been reported.

• Injection-site reactions, including redness, swelling and itching depending on the vaccine formulation and route of administration.
• Fever or flu-like symptoms in the days after a dose.
• Fatigue.
• Temporary effects related to blood-cell collection, such as light-headedness, bruising or tingling.

It can be difficult to determine whether an adverse effect is caused by the vaccine or by other treatments given at the same time. Safety findings may also differ between vaccine approaches.

Important limitations of dendritic cell therapy include:

• Tumor heterogeneity: glioblastoma contains different groups of tumor cells, so a vaccine may not target all of them equally.
• Immune suppression: glioblastoma can weaken immune responses around the tumor.
• Changing tumor targets: tumor cells may change or stop displaying antigens targeted by the immune response.
• Manufacturing: personalised vaccine production takes time and may not always be successful.
• Evidence gaps: long-term benefit has not yet been firmly established, and much of the evidence comes from non-randomized comparisons.
• Access: treatment is available only through selected centres or programmes.

Dendritic Cell Therapy in Germany: Specialist Care and Access

German centres have participated in clinical research on dendritic cell vaccination for brain tumors, including the DCVax-L study. Dendritic cell therapy may also be available through selected specialist programmes, but it is not part of routine guideline-based neuro-oncology care [2].

Assessment before treatment may include:

• Specialist review of the diagnosis, pathology and molecular findings.
• Review of previous treatments.
• Assessment of recent MRI scans and current disease status.
• Neurosurgical or neuropathology review where relevant.
• Confirmation that suitable tumor tissue is available where required.
• Multidisciplinary assessment when appropriate.

For international patients, medical records, pathology results and MRI scans are usually reviewed before treatment or travel arrangements are made. A specialist consultation can then determine whether further assessment is appropriate.

So how does a patient find out whether dendritic cell therapy in Germany is realistic in their case? 

A specialist assessment is needed to determine whether dendritic cell therapy may be suitable. The medical team will usually review the diagnosis, previous treatments, recent MRI scans, pathology and molecular findings, available tumor tissue where required, and the patient’s current clinical condition. TIG GmbH (Treatment in Germany) can support patients seeking assessment for dendritic cell therapy in Germany by facilitating medical-record review, connecting suitable cases with relevant specialists, and coordinating consultations where appropriate. Final decisions about eligibility, treatment recommendations and clinical care remain the responsibility of the German medical team.

References

1. Weller M, van den Bent M, Preusser M, Le Rhun E, Tonn JC, Minniti G, et al. (2021). EANO guidelines on the diagnosis and treatment of diffuse gliomas of adulthood. Nature Reviews Clinical Oncology, 18(3):170-186. European Association of Neuro-Oncology.

2. Liau LM, Ashkan K, Brem S, Campian JL, Trusheim JE, Iwamoto FM, et al. (2023). Association of autologous tumor lysate-loaded dendritic cell vaccination with extension of survival among patients with newly diagnosed and recurrent glioblastoma: a phase 3 prospective externally controlled cohort trial. JAMA Oncology, 9(1):112-121.

3. Parney IF, Anderson SK, Gustafson MP, Steinmetz S, Peterson TE, Kroneman TN, et al. (2022). Phase I trial of adjuvant mature autologous dendritic cell/allogeneic tumor lysate vaccines in combination with temozolomide in newly diagnosed glioblastoma. Neuro-Oncology Advances, 4(1):vdac089.

4. Lepski G, Bergami-Santos PC, Pinho MP, Chauca-Torres NE, Evangelista GCM, Teixeira SF, et al. (2023). Adjuvant vaccination with allogenic dendritic cells significantly prolongs overall survival in high-grade gliomas: results of a phase II trial. Cancers, 15(4):1239.

5. Bota DA, Taylor TH, Piccioni DE, Duma CM, LaRocca RV, Kesari S, et al. (2022). Phase 2 study of AV-GBM-1 (a tumor-initiating cell targeted dendritic cell vaccine) in newly diagnosed glioblastoma patients: safety and efficacy assessment. Journal of Experimental & Clinical Cancer Research, 41:344.

6. Katzendobler S, Do A, Weller J, Dorostkar MM, Albert NL, Forbrig R, et al. (2022). Diagnostic yield and complication rate of stereotactic biopsies in precision medicine of gliomas. Frontiers in Neurology, 13:822362.
   
   

Why Patients Worldwide Prefer Our Medical Services in Germany – Key Benefits Explained

International patients planning breast cancer treatment in Germany may need support with hospital consultations, medical documentation, translations, and travel arrangements. TIG GmbH helps coordinate these practical steps and communication with healthcare providers according to each patient's needs and the services agreed.

The table above compares the support and coordination services offered through TIG GmbH with the arrangements patients may need to manage when booking directly with a clinic.