Great advances in immune checkpoint blockade have resulted in a paradigm shift in patients with lung cancer. Immune-checkpoint inhibitor (ICI) treatment, either as monotherapy or combination therapy, has been established as the standard of care for patients with locally advanced/metastatic non-small cell lung cancer without EGFR/ALK alterations or extensive-stage small cell lung cancer. An increasing number of clinical trials are also ongoing to further investigate the role of ICIs in patients with early-stage lung cancer as neoadjuvant or adjuvant therapy. Although PD-L1 expression and tumor mutational burden have been widely studied for patient selection, both of these biomarkers are imperfect. Due to the complex cancer-immune interactions among tumor cells, the tumor microenvironment and host immunity, collaborative efforts are needed to establish a multidimensional immunogram to integrate complementary predictive biomarkers for personalized immunotherapy. Furthermore, as a result of the wide use of ICIs, managing acquired resistance to ICI treatment remains an inevitable challenge. A deeper understanding of the underlying biological mechanisms of acquired resistance to ICIs is helpful to overcome these obstacles. In this review, we describe the cutting-edge progress made in patients with lung cancer, the optimal duration of ICI treatment, ICIs in some special populations, the unique response patterns during ICI treatment, the emerging predictive biomarkers, and our understanding of primary and acquired resistance mechanisms to ICI treatment.

免疫检查点阻断的巨大进步导致肺癌患者发生了范式转变。免疫检查点抑制剂 (ICI) 治疗，无论是单一疗法还是联合疗法，已被确立为无EGFR/ALK改变的局部晚期/转移性非小细胞肺癌或广泛期小细胞肺癌患者的标准治疗。越来越多的临床试验也在进行中，以进一步研究 ICI 作为新辅助或辅助治疗在早期肺癌患者中的作用。尽管 PD-L1 表达和肿瘤突变负荷已被广泛研究用于患者选择，但这两种生物标志物都是不完善的。由于肿瘤细胞、肿瘤微环境和宿主免疫之间复杂的癌症免疫相互作用，需要共同努力建立多维免疫图，以整合互补的预测生物标志物以进行个性化免疫治疗。此外，由于 ICI 的广泛使用，管理对 ICI 治疗的获得性耐药仍然是不可避免的挑战。更深入地了解 ICI 获得性耐药的潜在生物学机制有助于克服这些障碍。在这篇综述中，我们描述了肺癌患者的前沿进展、ICI 治疗的最佳持续时间、某些特殊人群中的 ICI、ICI 治疗期间的独特反应模式、新兴的预测性生物标志物以及我们对原发性和ICI 治疗的获得性耐药机制。