Glioblastoma (GBM) is the most malignant primary brain tumor, characterized by extensive heterogeneity, invasiveness, infiltrating behavior, and resistance to standard therapies, including radiation and temozolomide (TMZ). Despite considerable efforts in investigating its pathophysiology, GBM represents one of the most challenging cancers to treat, with a median survival rate under 15 months and a 5-year survival rate below 5%. A major barrier to progress in GBM therapy development is the lack of reliable preclinical models that faithfully recapitulate the tumor’s molecular heterogeneity, invasive behavior, and complex microenvironment. Traditional cell lines and xenograft models often fail to reflect the key pathological features of human GBM, including immune suppression, vascular abnormalities, and treatment resistance. In recent years, attention has focused on the development of numerous clinically relevant GBM models based on brain organoids as a powerful “disease-in-a-dish” model. They strongly mimic GBM key histopathological and molecular features, such as the tumor’s cellular heterogeneity, genetic landscape, and microenvironment, enabling more accurate studies of tumor biology, invasion, and therapeutic response in a controlled in vitro setting. Notably, research in microgravity offers a unique and promising platform to study cancer biology under conditions that enhance tissue self-organization, mimic aspects of tumor growth, and potentially unveil novel therapeutic vulnerabilities. This review compares organoids to conventional preclinical models, tracing their historical development and salient features, focusing on the preparation and use of organoids in GBM research. We also introduce a novel and promising field of organoid application: space-based organoid brain research.

Background: High-grade glioma (HGG) is the most common primary malignant brain tumor, with peak incidence in the fifth and sixth decades of life. Although HGG is rare in children, the prognosis remains poor, with a median overall survival (OS) of less than two years. Recently, TRK inhibitors have been approved for the treatment of tumors harboring NTRK gene fusions. In this review, we analyzed data from early clinical trials investigating the use of these agents in patients with HGG. Methods: A systematic literature search was performed in the PubMed database. Studies involving patients with HGG treated with TRK inhibitors were included. We analyzed progression-free survival (PFS), 24-week disease control rate, and complete or partial radiological responses according to the Response Assessment in Neuro-Oncology (RANO) criteria. Results: Sixteen studies comprising 55 patients with HGG harboring NTRK gene fusions (19 adults and 36 children) were included. A statistically significant difference in PFS was observed between pediatric and adult patients treated with TRK inhibitors (17 vs. 8.5 months; p < 0.001). Pediatric patients also exhibited a higher rate of complete or partial radiological response compared to adults (94% vs. 57%). Discussion: Although the available evidence on TRK inhibitors in HGG is limited, the findings of this review highlight a potentially promising role for these agents, particularly in the treatment of pediatric HGGs.

Background/Objectives: Patients with unresectable glioblastoma (GBM) undergoing biopsy alone represent a clinically heterogeneous population with poor survival and limited access to standard oncological treatment. We investigated clinical, radiological, and histomolecular factors associated with early mortality after biopsy. Methods: We retrospectively analyzed 93 consecutive cases of patients with IDH-wildtype GBM who underwent biopsy without tumor resection between 2013 and 2025. Early death was defined as death within three months of biopsy. Baseline clinical, radiological, and molecular variables were evaluated using univariable analyses and exploratory multivariable logistic regression. Results: Median overall survival was 3 months, and 48/89 patients with available survival data (53.9%) died within three months. Preoperative Karnofsky Performance Status (KPS) and MGMT promoter methylation status (available for 71/93 patients) were nominally associated with early mortality in univariable analyses, although these associations did not remain significant after FDR correction. Age was not significant in univariable analysis but was associated with early mortality after adjustment in the exploratory multivariable model based on 62 complete cases. Conventional radiological parameters showed no consistent association with early death. Exploratory analysis suggested a high-risk phenotype combining KPS ≤ 60 and FLAIR signal crossing the midline. Overall, 23/93 patients (24.7%) did not initiate any adjuvant treatment, while only 17/93 (18.3%) completed the Stupp regimen. Conclusions: Early mortality is frequent in biopsy-only GBM. Clinical and molecular factors may help identify particularly vulnerable patients at diagnosis, supporting individualized treatment planning and shared decision-making. External validation in larger multicenter cohorts is warranted.