Fig. 6

PD-L1 expression changes contribute to resistance. Mutations in the JAK and EGFR genes result in the loss of PD-L1 expression, affecting antigen presentation. The lack of CXCL9, 10, and 11 expression prevents T cell chemotaxis in the tumor microenvironment, causing primary resistance. After PD-1 blockade, adaptive changes in various genes alter tumor cell metabolism, reduce MHC expression, and upregulate PD-L1, resulting in the inhibition of T cell activity and adaptive resistance