Inmunoterapia en CPNM resistente a TKI de EGFR: mecanismos, estrategias terapéuticas y desafíos emergentes

The epidermal growth factor receptor (EGFR) mutation represents one of the most prevalent driver gene alterations in non-small cell lung cancer (NSCLC) patients. EGFR tyrosine kinase inhibitors (EGFR-TKIs), particularly third-generation agents, have emerged as the top priority for patients harboring activating mutations. This review commences with a concise introduction to the EGFR-mutated tumor microenvironment and its dynamic changes associated with EGFR-TKI administration. We systematically summarize current therapeutic options for patients who progress on EGFR-TKIs, providing an overview of immunotherapy resistance mechanisms and corresponding management strategies. Finally, this review discusses the progression patterns and subsequent therapies in patients pretreated with EGFR-TKIs who develop resistance to immunotherapy. A treatment algorithm structured around resistance typology, molecular profiling, and progression patterns provides substantial clinical value for guiding therapeutic decisions in this patient population.