Glioblastoma care in Mexico and Latin America: a roadmap for closing the treatment gap

Glioblastoma, the most aggressive primary brain tumor in adults, remains one of neuro-oncology’s most stubborn challenges. Even with maximal safe surgical resection followed by radiotherapy and temozolomide chemotherapy, median overall survival hovers around 15 to 18 months, and durable long-term survival is uncommon. A new structured narrative review published in Frontiers in Oncology examines how this established standard of care can actually be delivered across Mexico and Latin America, where disparities in diagnostic capacity, treatment access, and continuity of care may further limit outcomes. The work, led by researchers at the National Institute of Neurology and Neurosurgery Manuel Velasco Suárez in Mexico City, proposes a resource-stratified framework intended to connect patients to the expertise they need without forcing them to abandon treatment along the way.

The review, which covered literature published from January 2005 through August 2026, draws on guidelines, consensus statements, randomized trials, registry-based studies, systematic reviews, meta-analyses, regional cohorts, and health-system evidence. Under the 2021 WHO Classification of Central Nervous System Tumors, the term glioblastoma is reserved for IDH-wildtype tumors, while IDH-mutant grade 4 astrocytic tumors are classified separately as astrocytoma. This molecular distinction matters enormously for treatment interpretation, because findings from IDH-mutant disease cannot be directly extrapolated to glioblastoma. The authors argue that integrated molecular diagnosis, combining histology with tests for IDH status, MGMT promoter methylation, and markers such as EGFR amplification, TERT promoter mutation, or the combined whole-chromosome +7/−10 signature, is the foundation on which every subsequent treatment decision rests.

The scale of the regional problem is difficult to quantify precisely, because available cancer registries rarely capture brain tumors at molecular resolution. GLOBOCAN 2024 estimated 27,774 new malignant brain and central nervous system cancer cases, 23,229 deaths, and 98,201 five-year prevalent cases across Latin America and the Caribbean. For Mexico alone, the corresponding estimates were 3,039 new cases, 2,583 deaths, and 10,751 five-year prevalent cases. Geographic access to radiotherapy represents a particularly stark constraint in Mexico: a national geospatial analysis found that 23.38 percent of the population, approximately 29.5 million people, lives at least 100 kilometers from the nearest radiotherapy facility, and only about one third of the population lives in a municipality that has one. Most centers are concentrated in state capitals or Mexico City.

These access barriers appear to translate into measurable survival differences, though the authors are careful to note that the evidence does not establish a causal effect for any individual barrier. A glioblastoma-specific meta-analysis of 24 studies including 2,552 patients from low- and middle-income countries reported a pooled median overall survival of 14.17 months, rising from 12.54 months in studies predating widespread adoption of the Stupp regimen of chemoradiotherapy to 15.64 months in later studies, without a significant difference according to World Bank income category. A separate meta-analysis of 12 studies including 143,303 patients found that lower individual economic status was associated with poorer survival, with a pooled hazard ratio of 1.09. The authors suggest these findings are not contradictory: national income is a coarse ecological measure, whereas individual socioeconomic disadvantage and failure to complete successive diagnostic and treatment steps sit closer to the care actually received.

Molecular testing gaps are among the most clinically consequential problems documented in the region. The LACOG 0619 study included 828 adults from nine Brazilian centers, in which glioblastoma represented 57 percent of the cohort; fewer than 20 percent of eligible patients underwent IDH sequencing, with marked differences in access to IDH, 1p/19q, MGMT, and next-generation sequencing between public and private institutions. An Argentine cohort of 443 surgically treated patients likewise found incomplete molecular characterization under the WHO 2021 criteria, reaching only 36 percent of assessed cases in 2024. A small Mexican cohort reported a higher frequency of IDH2 alterations, highlighting a potential limitation of relying exclusively on IDH1-R132H immunohistochemistry, which does not detect IDH2 mutations or non-canonical IDH1 variants. The review’s authors argue that the immediate regional priority is reliable access to core molecular testing rather than universal broad sequencing.

On the treatment side, the review reaffirms the established backbone: postoperative radiotherapy with concurrent and adjuvant temozolomide, typically 60 Gy in 30 fractions, remains the standard for adults with newly diagnosed glioblastoma suitable for combined-modality treatment. For older or frail patients, randomized evidence supports shorter courses, with 40 Gy in 15 fractions plus temozolomide improving survival compared with radiotherapy alone, particularly in MGMT-methylated disease. A separate randomized comparison supports 25 Gy in 5 fractions for selected elderly or frail patients, though the authors stress that the randomized evidence for temozolomide benefit in this setting derives from the 40 Gy regimen, and that travel burden alone should never justify treatment de-escalation in younger adults. Patients needing longer courses require transport, accommodation, and continuity planning rather than an unsupported reduction in treatment.

The review also takes a sober look at emerging therapies. Tumor-treating fields added to maintenance temozolomide improved progression-free and overall survival in the EF-14 trial, though their use depends on scalp toxicity, caregiver support, logistics, and affordability. In contrast, phase 3 trials of EGFR-directed approaches such as depatuxizumab mafodotin and rindopepimut failed to improve survival, and immune checkpoint inhibitors including nivolumab have not established a role in routine care, whether in recurrent or newly diagnosed disease. The REGOMA phase 2 trial reported longer survival with regorafenib than lomustine, but the larger GBM AGILE platform study did not confirm superiority and identified additional toxicity, so regorafenib should not be presented as a routine preferred standard. Early-phase approaches such as locoregional CAR-T therapy targeting IL13Rα2 or EGFR have shown intracranial activity but remain constrained by antigen heterogeneity, persistence, neurotoxicity, and manufacturing requirements, and should stay within appropriately designed clinical trials.

At the heart of the paper is a conceptual, bidirectional local-to-hub framework. Routine care remains local when quality standards can be met, while specialist centers provide complex diagnostics, advanced procedures, treatment review, recurrence assessment, and research access. Imaging, specimens, and treatment plans can often be reviewed remotely, avoiding unnecessary transfer of the entire course of care. When travel is required, the pathway should include logistical support and a defined plan for return to local care. The framework distinguishes established care from specialist-supported and investigational strategies, and proposes operational indicators to evaluate diagnostic timeliness, treatment completion, referral performance, supportive care, equity, and research access. The authors emphasize that these numerical targets, such as a proposed 80 percent completion of radiotherapy initiation within six weeks of surgery, are author-proposed planning examples rather than validated clinical thresholds.

External benchmarks help contextualize regional outcomes, though the authors caution against direct comparison. A regional Spanish study of 530 patients with IDH-wildtype glioblastoma diagnosed between 2011 and 2021 reported a median overall survival of 12.3 months, while a recent real-world cohort of 832 adults with WHO 2021-defined IDH-wildtype glioblastoma treated with radiotherapy reported a median of 13.0 months. The 2018–2022 CBTRUS report provides a population-based benchmark with a five-year relative survival of 7.0 percent among patients of all ages diagnosed with glioblastoma in 2004–2021, though this historical cohort lacked uniform molecular characterization. These studies illustrate the importance of distinguishing molecularly defined regional cohorts, real-world treatment outcomes, and population-level epidemiological estimates rather than treating them as interchangeable.

The review’s limitations are acknowledged candidly. The literature selection was narrative rather than systematic, without formal duplicate screening or risk-of-bias assessment. Regional evidence remains geographically and institutionally uneven, concentrated in a small number of countries and tertiary centers, leaving rural populations, different payer groups, and patients lost before pathological confirmation underrepresented. The referral model and operational targets have not been prospectively validated as a package. Still, the central message is clear: improving outcomes requires not only access to effective therapies, but reliable systems capable of delivering them consistently and equitably throughout the course of disease. The authors argue that regional capacity should be reframed not as a limitation to be accepted, but as a system that can be deliberately measured, strengthened, and evaluated over time.

Subject of Research: A structured narrative review of adult IDH-wildtype glioblastoma management and care-delivery implementation in Mexico and Latin America

Article Title: Adult IDH-wildtype glioblastoma in Mexico and Latin America: contemporary standards, emerging strategies, and an evidence-to-implementation roadmap

Article References: Rodríguez Camacho, A., Polito-Salazar, E., Blasco, X., Romero-Valencia, J. C., Fuentes-Calvo, I., Cid-Sánchez, D., Flores-Vázquez, J. G., Serrano-Murillo, M., Cacho-Díaz, B., González Vázquez, A., Santellán Hernández, J. O., Vega Moreno, D. A., Caballé-Pérez, E., San-Juan, D., García-Gómez, E., Ballesteros-Herrera, D., Wegman-Ostrosky, T., Chávez Martínez, O. A., Camarin Sánchez, E. I., … Moreno-Jiménez, S. (2026). Adult IDH-wildtype glioblastoma in Mexico and Latin America: contemporary standards, emerging strategies, and an evidence-to-implementation roadmap. Frontiers in Oncology, 16, Article 1998982. https://doi.org/10.3389/fonc.2026.1998982

Image Credits: AI Generated

DOI: 10.3389/fonc.2026.1998982

Keywords: glioblastoma, IDH-wildtype, Mexico, Latin America, molecular diagnostics, radiotherapy, temozolomide, health systems, health equity, neuro-oncology, implementation science, supportive care