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Tumor microenvironment-driven resistance to immunotherapy in non-small cell lung cancer: strategies for Cold-to-Hot tumor transformation.

作者信息

Yu Jinglu, Kong Xiaoni, Feng Yu

机构信息

Institute of Integrated Chinese and Western Medicine, PuDong Traditional Chinese Medicine Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 201200, China.

Institute of Respiratory Medicine, PuDong Traditional Chinese Medicine Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 201200, China.

出版信息

Cancer Drug Resist. 2025 Apr 24;8:21. doi: 10.20517/cdr.2025.14. eCollection 2025.


DOI:10.20517/cdr.2025.14
PMID:40342732
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12059482/
Abstract

Non-small cell lung cancer (NSCLC) represents a formidable challenge in oncology due to its molecular heterogeneity and the dynamic suppressive nature of its tumor microenvironment (TME). Despite the transformative impact of immune checkpoint inhibitors (ICIs) on cancer therapy, the majority of NSCLC patients experience resistance, necessitating novel approaches to overcome immune evasion. This review highlights shared and subtype-specific mechanisms of immune resistance within the TME, including metabolic reprogramming, immune cell dysfunction, and physical barriers. Beyond well-characterized components such as regulatory T cells, tumor-associated macrophages, and myeloid-derived suppressor cells, emerging players - neutrophil extracellular traps, tertiary lymphoid structures, and exosomal signaling networks - underscore the TME's complexity and adaptability. A multi-dimensional framework is proposed to transform cold, immune-excluded tumors into hot, immune-reactive ones. Key strategies include enhancing immune infiltration, modulating immunosuppressive networks, and activating dormant immune pathways. Cutting-edge technologies, such as single-cell sequencing, spatial transcriptomics, and nanomedicine, are identified as pivotal tools for decoding TME heterogeneity and personalizing therapeutic interventions. By bridging mechanistic insights with translational innovations, this review advocates for integrative approaches that combine ICIs with metabolic modulators, vascular normalizers, and emerging therapies such as STING agonists and tumor vaccines. The synergistic potential of these strategies is poised to overcome resistance and achieve durable antitumor immunity. Ultimately, this vision underscores the importance of interdisciplinary collaboration and real-time TME profiling in refining precision oncology for NSCLC, offering a blueprint for extending these advances to other malignancies.

摘要
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e195/12059482/8445ab926f4e/cdr-8-21.fig.2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e195/12059482/42e997dc0d33/cdr-8-21.fig.1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e195/12059482/8445ab926f4e/cdr-8-21.fig.2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e195/12059482/42e997dc0d33/cdr-8-21.fig.1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e195/12059482/8445ab926f4e/cdr-8-21.fig.2.jpg

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[1]
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[4]
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[5]
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[6]
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[7]
m6A methyltransferase METTL3 promotes non-small-cell lung carcinoma progression by inhibiting the RIG-I-MAVS innate immune pathway.

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[8]
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J Immunother Cancer. 2024-11-29

[9]
Blockade of purine metabolism reverses macrophage immunosuppression and enhances anti-tumor immunity in non-small cell lung cancer.

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[10]
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