Tumor microenvironment as the real immune checkpoint in intensive cancer care: are we targeting the wrong enemy?

Abstract

Immune checkpoint inhibitors have been termed a revolution in cancer treatment, with long-lasting benefits showing in a few cases, but recurrence and resistance are common. These constraints are seen to be associated with the tumor microenvironment (TME), which has been considered a complicated ecosystem that has an influence on immune activity in a suppressive manner. The phenomenon of escape from immunity has not been associated just with the presence of inhibitory receptors on Thymus-derived lymphocytes (T cells) but also with nutrient deprivation and stromal barriers, as well as the presence of suppressive immune cells. Provided that the receptor-ligand blockade continues to be taken as the sole solution, structural and functional obstacles in tumors can be neglected. In the case where the tumor microenvironment is viewed as the actual checkpoint, treatments can be guided towards more sustainable results.

Abbreviations: CTLA-4: Cytotoxic ECM: extracellular matrix, T-lymphocyte–associated antigen-4, PF-1: Programmed cell death protein-1, TME: tumor microenvironment

Keywords: Immune Checkpoint Inhibitors; Immunotherapy; T-Lymphocytes; Tumor Microenvironment

Citation: Batool A, Sana M. Tumor microenvironment as the real immune checkpoint in intensive cancer care: are we targeting the wrong enemy? Anaesth. pain intensive care 2026;30(3):288-90. DOI: 10.35975/apic.v30i3.3162

Received: October 01, 2025; Accepted: October 05, 2025