Efficacy and mechanisms of immune checkpoint inhibitors in late-stage EGFR-mutated non-small cell lung cancer following targeted therapy resistance

Currently, epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) represent the standard first-line treatment for advanced EGFR-mutated non-small cell lung cancer (NSCLC). However, as the disease progresses, targeted resistance inevitably develops. Chemoimmunotherapy, as the standard treatment for advanced NSCLC without driver gene mutations, has significantly improved patient survival. EGFR-mutant tumors exhibit unique immunogenicity compared to wild-type tumors, with heterogeneity in programmed death ligand 1(PD-L1) expression levels, tumor mutational burden (TMB), and other immune microenvironment characteristics. Therefore, we elucidate the mechanisms of immune resistance in EGFR-mutant patients and analyze the core immune mechanisms underlying EGFR-TKI resistance. We summarize the application of immune checkpoint inhibitors (ICIs) in advanced EGFR-mutant NSCLC and analyze the associated mechanisms of action.