Immunotherapy has become a key new pillar of cancer treatment, and this has sparked interest in understanding mechanisms of cancer immune evasion. It has long been appreciated that cancers are constituted by heterogeneous populations of tumour cells. This feature is often fuelled by specialized cells that have molecular programs resembling tissue stem cells. Although these cancer stem cells (CSCs) have capacity for unlimited self-renewal and differentiation, it is increasingly evident that some CSCs are capable of achieving remarkable immune resistance. Given that most immunotherapy regiments have overlooked CSC-specific immune-evasive mechanisms, many current treatment strategies often lead to cancer relapse. This Review focuses on advancements in understanding how CSCs in solid tumours achieve their unique immune-evasive properties, enabling them to drive tumour regrowth. Moreover, as cancers often arise from tissue stem cells that acquired oncogenic mutations, we discuss how tissue stem cells undergoing malignant transformation activate intrinsic immune-evasive mechanisms and establish close interactions with suppressive immune cells to escape immune surveillance. In addition, we summarize how in advanced disease stages, CSCs often hijack features of normal stem cells to resist antitumour immunity. Finally, we provide insights in how to design a new generation of cancer immunotherapies to ensure elimination of CSCs.

免疫疗法已成为癌症治疗的关键新支柱，这激发了人们对了解癌症免疫逃避机制的兴趣。长期以来，人们已经认识到癌症是由异质的肿瘤细胞群构成的。这种特征通常由具有类似于组织干细胞的分子程序的特殊细胞推动。尽管这些癌症干细胞 （CSC） 具有无限的自我更新和分化能力，但越来越明显的是，一些 CSC 能够实现显着的免疫抵抗力。鉴于大多数免疫治疗方案都忽视了 CSC 特异性免疫逃避机制，目前许多治疗策略通常会导致癌症复发。本综述侧重于了解实体瘤中的 CSCs 如何实现其独特的免疫逃避特性，使它们能够驱动肿瘤再生。此外，由于癌症通常起源于获得致癌突变的组织干细胞，我们讨论了经历恶性转化的组织干细胞如何激活内在的免疫逃避机制，并与抑制性免疫细胞建立密切相互作用以逃避免疫监视。此外，我们总结了在疾病晚期，CSCs 如何经常劫持正常干细胞的特征以抵抗抗肿瘤免疫。最后，我们就如何设计新一代癌症免疫疗法以确保消除 CSC 提供了见解。