Fig. 7.

CTX/L-NIL immunomodulation renders the tumor microenvironment receptive to CRT. Schematic abstract: The tumor immune microenvironment (both myeloid and lymphoid compartments) remains “cold” after CRT treatment, and is characterized by the infiltration of granulocytic MDSCs and regulatory T cells. However, the combination of CRT with CTX/L-NIL reverses these immunosuppressive effects and further promotes increases in M1-like macrophages and inflammatory monocytes in the tumor. This favorable myeloid alteration likely plays a role in the improved intratumoral CD8⁺ T cell response, which shows enhanced specificity, effector and memory phenotypes