Overcoming resistance to tumor-targeted and immune-targeted therapies
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Abstract
Resistance to anticancer therapies includes primary resistance, usually related to lack of target dependency or presence of additional targets, and secondary resistance, mostly driven by adaptation of the cancer cell to the selection pressure of treatment. Resistance to targeted therapy is frequently acquired, driven by on-target, bypass alterations, or cellular plasticity. Resistance to immunotherapy is often primary, orchestrated by sophisticated tumor–host–microenvironment interactions, but could also occur after initial efficacy, mostly when only partial responses are obtained. Here, we provide an overview of resistance to tumor and immune-targeted therapies and discuss challenges of overcoming resistance, and current and future directions of development. Significance: A better and earlier identification of cancer-resistance mechanisms could avoid the use of ineffective drugs in patients not responding to therapy and provide the rationale for the administration of personalized drug associations. A clear description of the molecular interplayers is a prerequisite to the development of novel and dedicated anticancer drugs. Finally, the implementation of such cancer molecular and immunologic explorations in prospective clinical trials could de-risk the demonstration of more effective anticancer strategies in randomized registration trials, and bring us closer to the promise of cure.
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Tumor heterogeneity, pathway redundancies, inherent tumor cell plasticity, and the complexity of the tumor microenvironment make acquired resistance an almost inevitable outcome of current therapies.
“However, tumor heterogeneity, pathway redundancies and inherent tumor cell plasticity, when combined with the complexity of the TME, renders acquired resistance an almost inevitable outcome of current therapies [113].”
From The HIF Axes in Cancer - Angiogenesis, Metabolism and Immune-Modulation (2025) · cites this paper as [113]
The Acquired Resistance to Targeted Therapy section identifies bypass pathways and phenotypic transformation as resistance mechanisms; Lineage Plasticity links cell plasticity and the tumor microenvironment to resistance. Improving the Characterization of Resistance also discusses tumor heterogeneity. These passages support the mechanisms named, but do not establish that acquired resistance is almost inevitable across current therapies. The supplied copy gives section labels but no page numbers. (LLM, conf=0.84)
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Cited by
Sorted by citations
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- Authors
- Aldea, M., Andre, F., Marabelle, A., Dogan, S., Barlesi, F., & Soria, J.-C.
- Affiliations
- Institut Gustave Roussy (FR)
- 1Department of Medical Oncology, Gustave Roussy, Villejuif, France.
- 2INSERM U981, PRISM Institute, Gustave Roussy, Villejuif, France.
- Université Paris-Saclay (FR)
- Corresponding author
- Soria, Jean-Charles
- Venue
- Cancer Discovery
- Published
- 2021-04-01
- Volume
- 11
- Issue
- 4
- Pages
- 874-899
- ISSN
- 2159-8274 (ISSN-L)
- 2159-8290
- OpenAlex
- W3142295235
- Cited by
- 311
- References
- 305
- Citations by year
- 2026: 47 · 2025: 93 · 2024: 67 · 2023: 46 · 2022: 40 · 2021: 17 · 2020: 1
- FWCI
- 5.21
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Cancer Discovery (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Oncology › Cancer Immunotherapy and Biomarkers
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Lung Cancer Treatments and Mutations
- Health Sciences › Medicine › Oncology › Cancer Cells and Metastasis
- Keywords
- drug resistance, targeted therapy, immunotherapy, primary resistance, secondary resistance, bypass signaling, cellular plasticity, tumor microenvironment, personalized drug combinations, anticancer drug development
- MeSH terms
- Humans, Immunotherapy, Neoplasms, Drug Resistance, Neoplasm, Precision Medicine
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