Reviews & Analysis

Transcriptional and epigenetic mechanisms governing T cell exhaustion substantially impact immunotherapy effectiveness. In this Review, Kang et al. outline epigenetic regulatory programmes that influence T cell differentiation fates, proposing strategies to enhance clinical outcomes and immunotherapy durability in cancer through improved understanding of T cell biology.

FLASH radiotherapy demonstrates reduced complications in healthy tissues while effectively targeting tumours. In this Perspective, Vozenin et al. review the clinical implications, mechanistic basis and provide novel hypotheses for FLASH efficacy.

In this Review, Mao et al. discuss the regulation and interplay of the metabolic cell death pathways ferroptosis, disulfidptosis and cuproptosis and explore how these mechanisms can be harnessed for cancer therapies.

Although ferroptosis, an iron-dependent form of regulated cell death, is emerging as a therapeutic vulnerability in cancer, clinical translation is hindered by context-dependent regulation, a lack of predictive biomarkers and challenges in clinical trial design. In this Review, Wahida and Conrad examine the biological basis of ferroptosis, including its immunogenic potential, and outline the necessary steps towards translating ferroptosis-based therapies into the clinic.

Antibody–drug conjugates are rapidly expanding both in the clinical treatment of cancer and in preclinical development. In this Review, Zippelius et al. highlight the molecular interactions and immune system effects of these sophisticated drugs that drive their efficacy and toxicity.

In this Review, Dong and Blanpain outline our current understanding of the epithelial-to-mesenchymal transition in cancer, which we now know is not a simple binary switch but the existence of a series of different tumour states. The authors also discuss the implications of this knowledge for pharmacologically targeting epithelial-to-mesenchymal transition to overcome therapy resistance.

In this Review, Kennel and Greten highlight the role of immune cells in colorectal cancer (CRC) development, progression and metastasis as well as the impact of therapies on the immune microenvironment. They emphasize the need for novel strategies to enhance immunogenicity and CRC patient stratification to improve outcomes.

Neurotoxicity impacting the central and peripheral nervous systems is a considerable adverse effect of both conventional and novel cancer therapies. In this Review, Karschnia et al. outline what is currently known about the mechanisms that underlie the clinical symptoms of central nervous system injury and peripheral neuropathy and the ongoing development of interventions to treat and prevent this unmet medical need.

In this Review, Easwaran and Weeraratna outline how ageing leads to epigenetic alterations in the tissue microenvironment, enhancing clonal expansion of mutations and ultimately increasing cancer risk.

In this Perspective, de Magalhães explores the evolutionary relationship between cancer and ageing, proposing that the need to minimize cancer risk early in life may contribute to tissue degeneration later on, representing a trade-off that constrains the evolution of longer lifespans.

Allogeneic haematopoietic stem cell transplantation remains the cornerstone of curative treatment for advanced myeloid malignancies. In this Perspective, Foldvari et al. propose that T cells engineered to express tumour-reactive T cell receptors (TCRs) may offer a safer and more effective alternative. They outline key considerations for identifying and validating suitable target antigens and matching TCRs, and for advancing these therapies towards clinical application.

Ageing reshapes immune composition, function and regenerative capacity, with profound effects on tumour immunity, cancer progression and treatment outcomes. In this Review, Dolan and colleagues examine how age-resolved immunoprofiling, insights from ageing haematopoiesis and preclinical modelling are uncovering immune ageing dynamics and therapeutic challenges — revealing new opportunities to optimize cancer therapy across diverse age groups.

Ageing influences cancer risk through cellular and environmental changes, including the induction of cellular senescence. In this Review, Ye, Melam and Stewart highlight the role of senescent stromal cells in cancer and the therapeutic implications of this.

Nanoparticle surfaces can be engineered for targeted delivery of cancer therapies. In this Review, Gomerdinger, Nabar and Hammond outline the role of surface chemistry at all levels of nanoparticle trafficking, from administration route, to tissue accumulation, cellular targeting and ultimately subcellular localization. They emphasize the utility of non-covalent surface modifications for improving stealth and targeting abilities of nanoparticles for cancer.

In this Review, Parida and Malladi summarize the metabolic adaptations of tumour cells upon dissemination to the brain, outline the metabolic crosstalk between cancer and brain-resident cells and discuss potential strategies to target these adaptations to improve outcomes for patients with brain metastasis.

In this Perspective, Lazure and Gomes argue that metabolic changes that occur as a result of ageing may shape tumour initiation and progression and the development of metastatic disease.

In this Review, Henry and DeGregori discuss the contributions of the various models and methods used to study the connection between ageing and cancer, highlighting the strengths and limitations of those models and technologies, as well as advocating for the wider adoption of age-appropriate models of cancer to improve our clinical translation of approaches to prevent and treat human cancers.

Comparative oncology combines evolutionary biology, ecology, veterinary medicine and clinical oncology to better understand cancer, for example, by identifying the molecular and cellular mechanisms underlying the remarkable cancer resistance of some taxa. Therefore, this Perspective by Vincze et al. calls for the increased use of non-conventional model organisms in cancer research to advance cancer prevention and treatment strategies.

The endoplasmic reticulum (ER) has a central role in mounting effective and durable antitumour immunity. In this Review, Hwang et al. outline how tumour-induced ER stress responses alter the function of intratumoural immune cells and the efficacy of immunotherapy, highlighting the potential of unfolded protein response-targeted interventions to improve cancer outcomes.

The nervous and immune systems have co-evolved to respond to threats, including cancer. In this Review, Amit et al. outline the reciprocal interactions among neurons, immune cells and tumour cells that regulate peripheral antitumour immune responses and discuss how these mechanisms could be leveraged to enhance immunotherapy.