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Dissecting the immune evasion and therapeutic resistance mechanisms in EGFR/TP53 co-mutated non-small cell lung cancer: implications for targeted and immunotherapy strategies.


ABSTRACT:

Background

Although precision-targeted therapies and tyrosine kinase inhibitors (TKIs) have significantly improved outcomes in non-small-cell lung cancer (NSCLC), patients with EGFR-mutant NSCLC with concurrent TP53 mutations often develop drug resistance and experience poor clinical outcomes. This study aims to investigate the molecular mechanisms underlying this aggressive subtype using single-cell RNA sequencing.

Methods

Formalin-fixed paraffin-embedded (FFPE) tumor samples were obtained from 40 hospitalized NSCLC patients. Somatic mutation profiles were determined using a targeted 23-gene next-generation sequencing (NGS) panel. Four samples harboring concurrent EGFR and TP53 mutations were selected for single-cell transcriptomic profiling using the 10x Genomics platform.

Results

Two dominant malignant epithelial cell populations were identified: C1_EGFR+, associated with proliferation and invasion, and C2_STAT1+, linked to immunosuppression and drug resistance. These tumor subtypes cooperatively drive CD8+ T cell exhaustion through the MDK-(ITGA4+ITGB1), MIF-(CD74+CXCR4), and TGF-β signaling pathways. In addition, antigen-presenting cancer-associated fibroblasts (apCAFs) recruit regulatory T cells via the CCL5-CCR4 axis, collectively establishing an immune-excluded tumor microenvironment. Mechanistically, a STAT1/ETS1-centered transcriptional program regulates the expression of key immunosuppressive (e.g., MDK, MIF, TGFB1) and resistance-associated genes (e.g., ERBB2, JAK2).

Conclusion

These findings reveal a coordinated transcriptional network that promotes immune evasion and therapeutic resistance in EGFR/TP53 co-mutated NSCLC. Targeting the STAT1/ETS1 axis, in combination with EGFR-TKIs or immune checkpoint inhibitors, may provide a novel strategy to overcome resistance and improve patient outcomes. Further validation in larger patient cohorts and functional studies is warranted to confirm these observations and support clinical translation.

SUBMITTER: Shi H 

PROVIDER: S-EPMC12425899 | biostudies-literature | 2025

REPOSITORIES: biostudies-literature

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Publications

Dissecting the immune evasion and therapeutic resistance mechanisms in EGFR/TP53 co-mutated non-small cell lung cancer: implications for targeted and immunotherapy strategies.

Shi Haiyan H   Xu Kun K   Kong Xueying X   Xie Weining W   Chen Yingying Y   He Ding D   Cheng Zufu Z   Huo Xianshan X   Gao Ke K   Song Mingshuang M   Tian Ning N  

Frontiers in immunology 20250829


<h4>Background</h4>Although precision-targeted therapies and tyrosine kinase inhibitors (TKIs) have significantly improved outcomes in non-small-cell lung cancer (NSCLC), patients with EGFR-mutant NSCLC with concurrent TP53 mutations often develop drug resistance and experience poor clinical outcomes. This study aims to investigate the molecular mechanisms underlying this aggressive subtype using single-cell RNA sequencing.<h4>Methods</h4>Formalin-fixed paraffin-embedded (FFPE) tumor samples wer  ...[more]

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