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Resistance to immune checkpoint inhibitors in KRAS-mutant non-small cell lung cancer
Yunchang Li1,2, Lanlin Hu1,2, Xinhao Peng1
1Integrative Cancer Center and Cancer Clinical Research Center, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu 610042, Sichuan, China.
Abstract:
Non-small cell lung cancer (NSCLC) patients with Kirsten rat sarcoma viral oncogene homolog (KRAS) mutation are associated with significant clinical heterogeneity and a poor prognosis to standard NSCLC therapies such as surgical resection, radiotherapy, chemotherapies, and targeted medicines. However, the application of immune checkpoints inhibitors (ICIs) has dramatically altered the therapeutic pattern of NSCLC management. Clinical studies have indicated that some KRAS-mutant NSCLC patients could benefit from ICIs; however, the responses in some patients are still poor. This review intends to elucidate the mechanisms of resistance to immunotherapy in KRAS-driven NSCLC and highlight the TME functions altered by immunoinhibitors, immunostimulators, and cancer metabolism. These metabolic pathways could potentially be promising approaches to overcome immunotherapy resistance.
Insights
KRAS-mutant non-small cell lung cancer (NSCLC) shows varied responses to immunotherapy. This review explores resistance mechanisms and highlights metabolic pathways as potential strategies to improve treatment outcomes for NSCLC patients.
Area of Science:
- Oncology
- Immunotherapy
- Cancer Metabolism
Background:
- Non-small cell lung cancer (NSCLC) with KRAS mutations presents clinical heterogeneity and poor prognosis with standard therapies.
- Immune checkpoint inhibitors (ICIs) have transformed NSCLC treatment, yet some KRAS-mutant NSCLC patients exhibit resistance.
- Understanding resistance mechanisms is crucial for optimizing immunotherapy in KRAS-mutant NSCLC.
Purpose of the Study:
- To elucidate mechanisms of immunotherapy resistance in KRAS-driven NSCLC.
- To highlight the role of the tumor microenvironment (TME) in immunotherapy response.
- To identify potential therapeutic strategies targeting cancer metabolism to overcome resistance.
Main Methods:
- Literature review focusing on KRAS mutations in NSCLC and immunotherapy response.
- Analysis of studies investigating tumor microenvironment alterations.
- Exploration of cancer metabolism pathways in the context of immunotherapy resistance.
Main Results:
- KRAS mutations influence TME composition and function, impacting ICI efficacy.
- Immunoinhibitors and immunostimulators modulate the TME in KRAS-mutant NSCLC.
- Aberrant cancer metabolism pathways contribute to immunotherapy resistance.
Conclusions:
- Targeting specific metabolic pathways in the TME may overcome immunotherapy resistance in KRAS-mutant NSCLC.
- Further research into TME modulation and metabolic reprogramming is warranted.
- Personalized therapeutic strategies integrating immunotherapy with metabolic interventions show promise for improved patient outcomes.
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