Tumor microenvironment and drug resistance in lung adenocarcinoma: molecular mechanisms, prognostic implications, and therapeutic strategies

Abstract

Abstract The fight against lung adenocarcinoma (LUAD) is challenged by tumor microenvironment (TME)-mediated drug resistance, which limits effective treatment. This study examines the LUAD TME and identifies four distinct subtypes through multi-omics profiling: immune-rich, immune-exhausted, stromal-dominant, and TME-desert. Each subtype has unique molecular features, tumor diversity, and links to clinical outcomes. Immune-rich subtypes respond better to immune checkpoint inhibitors, while stromal-dominant and TME-desert subtypes show resistance to treatment and poor prognosis. Molecular analysis uncovers subtype-specific mutations, chromosomal instability, and altered signaling pathways, pointing to potential therapeutic targets. In silico drug screening identifies promising treatments for resistant subtypes. These findings, validated in independent cohorts, highlight the critical role of the TME in drug resistance and treatment response, providing insights for personalized treatment strategies in LUAD.

Keywords

• Lung adenocarcinoma
• Tumor microenvironment
• PD-1/PD-L1 pathway
• Molecular subtypes
• Therapeutic strategies