Novel Insights into the Role of circRNAs in Cancer Immunotherapy Resistance and Clinical Implications

Cancer therapies are increasingly reliant on immunotherapeutic interventions; however, the persistent emergence of primary, adaptive, and acquired resistance severely limits durable clinical efficacy. Circular RNAs (circRNAs), distinguished by their extreme structural stability and covalently closed loops, have recently been established as potent orchestrators of this immune evasion. This review systematically synthesizes current advancements detailing how circRNAs undermine anti-tumor immunity across diverse malignancies. Specifically, we delineate their critical roles in post-transcriptionally upregulating immune checkpoint molecules (e.g., PD-L1), mediating intercellular immunosuppression via exosomal transfer, and metabolically reprogramming the tumor microenvironment to drive CD8+ T-cell exhaustion and macrophage polarization. Ultimately, we conclude that translating these molecular insights into clinical practice is paramount. Beyond serving as predictive biomarkers, engineering circRNA-targeted therapies and exploiting tumor-specific circRNAs to develop novel anti-tumor vaccines represent essential, paradigm-shifting strategies to definitively overcome immune checkpoint inhibitor resistance.