Narrative review examines driver mutations and immunotherapy response in non-small cell lung cancerDoes your lung cancer's genetic makeup change how well immune therapy works?

This narrative review addresses the impact of targetable driver gene alterations, including EGFR, ALK, KRAS, MET, RET, and BRAF mutations, on the tumor immune microenvironment in patients with non-small cell lung cancer. The scope encompasses how these oncogenic drivers actively shape the microenvironment by regulating antigen presentation, immune cell infiltration, cytokine signaling, metabolic programs, and immune checkpoint expression. The review does not report specific sample sizes, absolute numbers, or statistical measures such as p-values or confidence intervals.

The authors note that the efficacy of immunotherapy varies markedly across molecular subtypes defined by these targetable driver gene alterations. While the review provides a rationale for precision immunotherapy strategies and the design of biomarker-driven clinical trials, it does not present pooled effect sizes or adverse event rates. Consequently, the evidence remains qualitative rather than quantitative.

Limitations acknowledged by the authors include the absence of reported follow-up durations and specific safety data. The review does not establish causal relationships or provide definitive trial-level data. Clinicians should interpret these findings as a conceptual framework rather than evidence for specific dosing or outcome predictions in individual patients.