Tumor mutational burden shapes success and resistance in cancer immunotherapy

Abstract

Immunotherapy, particularly immune checkpoint blockade, has transformed cancer treatment, yet durable responses remain limited to a subset of patients and cancer types. Many tumors exhibit innate resistance or acquire resistance through immune evasion or neoantigen editing. A central factor in shaping these outcomes is the tumor mutational burden. However, cancer mutations can enhance or impair both cellular replication and immune recognition, reflecting the non-trivial role of mutational load in immunotherapy success and failure. Here, we present a minimal eco-evolutionary model that captures trade-offs between oncogenic and immunogenic mutations in cancer cell replication. Despite its simplicity, the model reveals a rich phase space, including an evolutionary bistable regime where both immunologically silent and mutationally active tumor strategies can coexist. Notably, the model explains two key eco-evolutionary mechanisms of resistance to immunotherapy: preexisting resistance, driven by the persistence of silent clones within genetically unstable tumors; and immunoediting, where immune pressure selects for reduced antigenicity over time.