Crackare il codice della resistenza all'immunoterapia nel cancro al polmone piccolo: insight molecolari e soluzioni emergenti.

Small cell lung cancer (SCLC) is an aggressive neuroendocrine malignancy with dismal prognosis. Although immune checkpoint inhibitors (ICIs) have revolutionized non-small cell lung cancer, their impact in SCLC has been modest, with only 2-3 months' improvement in median survival. This paradox persists despite SCLC's high tumor mutational burden, suggesting complex, multifactorial resistance mechanisms. Here we critically review the latest advances in understanding immunotherapy resistance in SCLC. We highlight tumor-intrinsic immune escape mechanisms, including genetic drivers, MHC class I downregulation, and epigenetic repression, as well as the profoundly immunosuppressive tumor microenvir