Reck Martin, Frost Nikolaj, Peters Solange, Fox Bernard A, Ferrara Roberto, Savai Rajkumar, Barlesi Fabrice
Department of Thoracic Oncology, Airway Research Center North, German Center for Lung Research, LungenClinic, Grosshansdorf, Germany.
Department of Infectious Diseases and Pulmonary Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt Universität Berlin, and Berlin Institute of Health, Berlin, Germany.
Nat Rev Clin Oncol. 2025 Aug 14. doi: 10.1038/s41571-025-01061-7.
The treatment landscape of non-small-cell lung cancer (NSCLC) has evolved considerably with the integration of immune-checkpoint inhibitors (ICIs) into first-line regimens. However, the majority of patients will ultimately have primary resistance or develop secondary resistance, driven by a complex interplay of intrinsic tumour biology and adaptive changes within the tumour microenvironment (TME), which can be further amplified by host-related factors such as dysbiosis and organ-specific conditions. Despite these heterogeneous origins, most mechanisms of resistance to ICIs lead to an immunosuppressive TME as the final common pathway. Consequently, current strategies designed to overcome resistance aim to restore antitumour immunity via antibody-based therapies (including bispecific antibodies, T cell engagers and antibody-drug conjugates), targeted therapies, adoptive cell therapies, therapeutic vaccines or intratumoural immunotherapies. Although substantial progress has been made in identifying potential biomarkers associated with immune resistance, the clinical relevance of many of these observations remains limited. Biomarker-driven studies using adaptive, hypothesis-generating designs might offer a promising path forward by navigating the complexity of resistance and enabling the timely evaluation of novel therapeutic concepts. In this Review, we summarize the latest advances in addressing resistance to ICIs in patients with advanced-stage NSCLC and provide insights into emerging clinical strategies and future research directions.
随着免疫检查点抑制剂(ICI)纳入一线治疗方案,非小细胞肺癌(NSCLC)的治疗格局发生了显著变化。然而,由于肿瘤内在生物学特性与肿瘤微环境(TME)内适应性变化的复杂相互作用,大多数患者最终会出现原发性耐药或继发性耐药,宿主相关因素(如生态失调和器官特异性状况)可进一步加剧这种情况。尽管耐药起源各异,但大多数ICI耐药机制最终都会导致免疫抑制性TME这一共同途径。因此,目前旨在克服耐药性的策略旨在通过基于抗体的疗法(包括双特异性抗体、T细胞衔接器和抗体药物偶联物)、靶向疗法、过继性细胞疗法、治疗性疫苗或瘤内免疫疗法来恢复抗肿瘤免疫力。尽管在识别与免疫耐药相关的潜在生物标志物方面取得了重大进展,但其中许多观察结果的临床相关性仍然有限。采用适应性、产生假设设计的生物标志物驱动研究,可能通过应对耐药的复杂性并及时评估新的治疗概念,为未来提供一条充满希望的道路。在本综述中,我们总结了晚期NSCLC患者ICI耐药应对方面的最新进展,并对新兴临床策略和未来研究方向提供见解。
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