ReviewMolecular and clinical oncology2026
Tumor microenvironment-mediated resistance to immune checkpoint inhibitors in non-small cell lung cancer: Mechanisms, combination strategies and clinical perspectives (Review).
Review in Molecular and clinical oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Abstract
Non-small cell lung cancer (NSCLC) is one of the leading causes of cancer-associated mortality worldwide. Immune checkpoint inhibitors targeting programmed cell death protein 1, programmed death-ligand 1 (PD-L1) and cytotoxic T lymphocyte-associated protein 4 have transformed the treatment landscape of NSCLC. However, primary and acquired resistance limit durable clinical benefit. The current review article aimed to summarize tumor microenvironment-mediated resistance as an interconnected biological process rather than a collection of isolated factors. Immunosuppressive myeloid populations, regulatory lymphocytes, cancer-associated fibroblasts, extracellular matrix remodeling, vascular endothelial growth factor-driven vascular dysfunction, hypoxia, transforming growth factor-β signaling and metabolic reprogramming cooperate with defects in antigen presentation, dysregulation of serine/threonine kinase 11/Kelch-like ECH-associated protein 1/nuclear factor erythroid 2-related factor 2/stimulator of interferon genes and oncogenic driver signaling to generate immune-desert (minimal immune cell infiltration), immune-excluded (immune cells retained outside tumors) or exhausted immune-inflamed (immune-cell infiltration with functional exhaustion) phenotypes. The present review also critically evaluated combination therapeutic strategies, distinguishing phase III-supported standards from early-phase clinical or preclinical approaches, while highlighting considerations associated with patient selection, toxicity and the evolving regulatory context. Finally, an operational biomarker framework integrating PD-L1 expression, tumor mutational burden, interferon γ-associated signatures, spatial profiling, circulating tumor DNA, exosomal biomarkers and microbiome features was proposed to guide precision immunotherapy in NSCLC.
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