Soil and Seed: Tumor Microenvironment Nurtures Immunotherapy Resistance and Renewal

TL;DR

This review explores how the tumor microenvironment causes resistance to cancer immunotherapies and suggests ways to overcome these barriers.

Contribution

The paper provides a systematic comparison of resistance mechanisms in ICIs and CAR-T therapies and proposes emerging strategies to counteract them.

Findings

The tumor microenvironment contributes to immunotherapy resistance through cellular, metabolic, and microbial factors.

Common resistance mechanisms exist between immune checkpoint inhibitors and CAR-T therapies.

Emerging strategies like stromal normalization and microbiota engineering show promise in overcoming resistance.

Abstract

Cancer immunotherapy has become a powerful clinical strategy for cancer management, while its efficacy is frequently limited by primary and acquired resistance. The tumor microenvironment (TME) plays a pivotal role in mediating such resistance through multifaceted mechanisms involving cellular, metabolic, mechanical, and microbial components. This review systematically examines how the TME contributes to immunotherapy failure. We compare resistance mechanisms common to both immune checkpoint inhibitors (ICIs) and chimeric antigen receptor T-cell (CAR-T) therapies, two cornerstone modalities in clinical practice. Furthermore, we discuss emerging strategies designed to overcome these barriers, including immune microenvironment, stromal normalization, metabolic modulation, and microbiota engineering. By integrating recent preclinical and clinical insights, this review aims to provide a comprehensive framework for understanding and targeting microenvironmental resistance, ultimately facilitating the translation of novel combination therapies into improved patient outcomes.

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