Risposta e resistenza all'immunoterapia nel cancro endometriale: integrazione di sottotipo molecolare, stati immuni spaziali e biomarcatori farmacodinamici.

BACKGROUND: Immunotherapy has reshaped the treatment landscape of endometrial cancer (EC), yet durable benefit remains heterogeneous, particularly outside mismatch repair-deficient disease. Current patient-selection strategies still rely heavily on static baseline biomarkers and often fail to explain non-response at the tissue level. MAIN BODY: This review synthesizes current evidence on immunotherapy response and resistance in EC and discusses a constraint-based framework linking TCGA/ProMisE molecular classes to recurring spatial immune states, including inflamed, immune-excluded, and immune-desert phenotypes. Within this framework, resistance can be interpreted through three coupled, tis