The Paradoxical Role of Pyroptosis in Gastrointestinal Cancers: From Molecular Mechanisms to Therapeutic Horizons

Pyroptosis, a gasdermin-mediated and highly immunogenic form of regulated cell death, has surfaced as a critical determinant in the progression and therapeutic landscape of gastrointestinal (GI) cancers. Unlike non-inflammatory apoptotic pathways, pyroptosis involves the assembly of inflammasome complexes and the subsequent activation of caspases, leading to the cleavage of gasdermin proteins and the formation of transmembrane pores. It contributes to tumor suppression via immunogenic cell death and activation of antitumor immunity but may also promote tumor progression through chronic inflammation and remodeling of the tumor microenvironment. In this comprehensive review, we delineated the molecular architecture of pyroptotic signaling within the GI tract, highlighting the “double-edged sword” nature of this process. We further evaluated its role in the pathogenesis of GI cancers and in emerging translational strategies, including the pharmacological modulation of gasdermins and microbiome-based interventions, aiming to integrate pyroptosis induction into current immunotherapeutic frameworks.