Autophagy Modulation in Cancer Immunotherapy, Emerging Molecular Targets and Drug Selection Strategies

Cancer immunotherapy has revolutionized the treatment of cancer by harnessing the immune system to recognize and destroy malignant cells. However, a substantial proportion of patients exhibit primary or acquired resistance to these therapies, underscoring the urgent need to identify novel molecular targets to enhance therapeutic efficacy. Autophagy, an evolutionarily conserved cellular process of degradation and recycling, has emerged as a critical modulator of tumor immunity and the function of immune cells. In cancer cells, autophagy modulates antigen presentation, immunogenic cell death, metabolic reprogramming, and resistance to immune-mediated cell death. Concurrently, autophagy rigorously governs the viability, differentiation, and functional capacity of immune cells, including T cells, dendritic cells, macrophages, and natural killer (NK) cells. Dysfunctional autophagic flux in the tumor microenvironment can enhance immune evasion and limit the efficacy of immune checkpoint inhibitors, adoptive cell therapies, and cancer vaccines. In this review, we provide an in-depth analysis of emerging molecular targets involved in the regulation of autophagy relevant to cancer immunotherapy. This includes key signaling pathways such as PI3K/AKT/mTOR, AMPK, Beclin-1 complexes, ULK1, and lysosomal regulators. Additionally, we explore the rational integration of the pharmacological modulation of autophagy, including small molecules, natural compounds, and nanoparticle-based drug delivery systems, with immunotherapeutic approaches. We highlight the importance of rational drug selection and combination therapies to overcome resistance to immunotherapy and minimize toxicity. Understanding the context-dependent role of autophagy will be essential for the development of next-generation, precision-targeted cancer immunotherapies. Therefore, a comprehensive understanding of the context-specific functions of autophagy in tumor and immune cells is crucial for devising precision-targeted combination methods that overcome immunotherapy resistance and produce more sustainable cancer treatment outcomes.