Gynaecological tumours, including cervical cancer (CC), endometrial cancer (EC), and ovarian cancer (OC), represent a significant global health burden for women.

In recent years, both the incidence and mortality rates of these malignancies have exhibited an upward trend, particularly in low- and middle-income countries.

CC ranks fourth in terms of both incidence and mortality among female cancers worldwide, with more than 70% of cases occurring in resource-limited settings.

Despite the widespread implementation of screening programmes, the global survival rate for women with CC has remained stagnant, and the prognosis of metastatic or recurrent disease remains dismal. EC is among the most common gynaecologic malignancies in developed countries.

Its mortality rate has steadily increased over the past decade, with a 5-year survival rate of only 16% in patients with distant metastases.

Ovarian cancer, which is often diagnosed at an advanced stage because of a lack of early symptoms and effective screening tools, remains the most lethal gynaecologic cancer.

In the United States, it is estimated that approximately 60.9% of newly diagnosed OC cases in 2025 will result in mortality, with a 5-year relative survival rate of only 31% for those with advanced-stage disease.

Although standard treatment strategies—comprising surgery and platinum-based chemotherapy—have improved overall outcomes, many patients experience recurrence and progression, highlighting the urgent need for more effective therapeutic approaches.

This paper was published in the Chinese Medical Journal on June 17, 2026. Immunotherapy has emerged as a transformative strategy in cancer treatment, offering durable responses and survival benefits in various malignancies, including non-small cell lung cancer and melanoma.

Encouraged by these successes, immunotherapy is being actively explored in the context of gynaecologic tumours.

Immunotherapeutic modalities such as immune checkpoint inhibitors (ICIs), adoptive cell therapy (ACT), antibody–drug conjugates (ADCs), and oncolytic virus-based vaccines have shown promising clinical potential; these treatments reactivate antitumor immunity and enhance immune recognition by tumour cells.

Among these treatment options, ICIs targeting PD-1/PD-L1 or CTLA-4 have demonstrated notable efficacy, particularly in patients with PD-L1-positive tumours.

However, the complex and highly heterogeneous tumour immune microenvironment (TIME) in gynaecologic cancers—especially OC—poses a major challenge to immunotherapy success.

The TME not only facilitates immune evasion through various mechanisms but also supports tumour growth, angiogenesis, and metastasis via dynamic crosstalk between tumour cells and infiltrating immune cells.

Mounting evidence suggests that the density, phenotype, and functional status of tumour-infiltrating lymphocytes (TILs), particularly cytotoxic CD8⁺ T cells, are closely associated with clinical outcomes and the response to immunotherapy.

Nevertheless, tumour cells can impair T-cell activity through multiple immunosuppressive pathways involving regulatory T cells (Tregs), myeloid-derived suppressor cells (MDSCs), inhibitory cytokines, and immune checkpoint molecules.

Moreover, the immunological landscape of tumours is influenced by additional factors, such as somatic mutations, abnormal angiogenesis, altered cellular metabolism, and shifts in the tumour-associated microbiome.

Given these complexities, a deeper understanding of the immune landscape in gynaecologic tumours and the mechanisms driving immune escape is essential to increasing the efficacy of immunotherapy.

This review aims to systematically summarise recent progress in immunotherapy for gynaecologic cancers, with a focus on the characteristics of the TME, underlying immune evasion mechanisms, current clinical applications, and emerging therapeutic strategies.

We also discuss future directions for precision immunotherapy, aiming to provide a theoretical foundation and practical guidance for optimising treatment strategies and improving patient prognosis.

Article: Immunotherapy for gynecological tumors: From mechanism to clinical practice

Source: Chinese Medical Journals Publishing House Co., Ltd.