Testicular germ cell tumors (TGCT) are the leading malignancy in adolescent and young adult males, yet the immunological and cellular mechanisms governing their tumor microenvironment (TME) remain poorly understood. Here, we present a comprehensive review of TGCT pathobiology with a focus on the immune landscape, particularly the role of tumor-infiltrating T lymphocytes. The mammalian testis represents an immune-privileged organ maintained by the coordinated actions of somatic cells (Sertoli and Leydig cells) and resident immune populations that collectively foster immune tolerance and suppress deleterious inflammatory responses. Immune privilege is disrupted in TGCT, resulting in significant alterations in the composition and function of immune cell subsets such as macrophages, mast cells, dendritic cells, and especially T cells. The phenotypic diversity and functional adaptability of CD4+ T cell subsets (Th1, Th2, Th9, Th17, Th22, Treg, and Tfh) along with CD8+ T cell subsets (Tc1, Tc2, Tc9, Tc17, and Tc22) are critically evaluated in terms of their roles in anti-tumor immune responses, modulating immune regulation, and enabling tumor immune evasion within the TME of TGCT. Despite the success of immunotherapies such as immune checkpoint inhibitors targeting PD-1/PD-L1 and CTLA4, and emerging CAR-T cell strategies in other malignancies, their efficacy in TGCT is limited due to the unique testicular immune milieu and limited understanding of T cell dynamics in TME. Recent advances in single-cell transcriptomics and clinical studies highlight the necessity for high-resolution characterization of T cell subpopulations and their intercellular interactions within the TGCT TME. Elucidating these mechanisms is critical for the rational development of novel immunotherapeutic strategies aimed at overcoming resistance, minimizing long-term treatment-related sequelae, and enhancing clinical outcomes for TGCT patients.
Islam et al. (Tue,) studied this question.