A Multimodal Framework to Guide Solid Tumor Indications for Natural Killer Cell-Based Therapy

T cell-based immunotherapies have achieved remarkable success in hematological malignancies but remain limited in solid tumors. Natural killer (NK) cells offer a compelling complementary approach, given their ability to recognize and kill tumor cells independently of neoantigen presentation and MHC class I expression. This study integrates multiomic analyses, clinical trial data, and transcriptomic analyses to systematically identify solid tumor indications most likely to benefit from NK cell-based therapies. Immunohistochemical analysis revealed that NK cells infiltrate multiple tumor types, with the highest abundance in kidney tumors. Systematic review of 177 clinical trials identified variable efficacy across solid tumor indications, without a clearly superior tumor type or intervention. Transcriptomic profiling of over 10,000 TCGA samples assessed NK cell infiltration, cytotoxic fitness, and tumor microenvironment composition, highlighting kidney renal cell carcinoma, lung adenocarcinoma and squamous cell carcinoma, cervical and endocervical cancers, and mesothelioma as promising candidates for future clinical evaluation. Together, these findings provide a multimodal framework to prioritize tumor indications and improve the rational design of future NK cell clinical trials.