Mechanisms of traditional Chinese medicine in enhancing the efficacy and reducing the toxicity of immune checkpoint inhibitors <i>via</i> regulation of the tumor microenvironment and gut microbiota

Immune checkpoint inhibitors (ICIs) face challenges of drug resistance and immune-related adverse events (irAEs). Traditional Chinese medicine (TCM)-including single herbs, compounds, and active monomers-enhances ICI efficacy and reduces toxicity by remodeling the tumor immune microenvironment, regulating gut microbiota, and modulating key immune pathways. TCM also alleviates ICI-induced colitis and myocarditis, demonstrating the value of holistic and syndrome-differentiated therapy. Future research should clarify synergistic mechanisms to advance precise integration of TCM and ICI immunotherapy.