Unleashing T cell surveillance for the eradication of quiescent persister tumor cells resistant to neoadjuvant chemotherapy.

Although neoadjuvant chemotherapy (NAC) has shown efficacy in reducing tumor burden in colorectal cancer (CRC), its impact on long-term patient outcomes remains limited. Here, we identify quiescent persister tumor cells (PTCs) as a critical determinant of therapeutic failure. Elevated PTC abundance correlates with poor long-term prognosis, even in patients exhibiting an initial response to treatment. Quiescent PTCs possess aggressive stem-like traits and orchestrate an immunosuppressive microenvironment characterized by CD96CD8 T cell infiltration in an orthotopic CRC mouse model. CD96 depletion diverts CD8 T cells from an exhaustion trajectory and promotes memory-like phenotypes through enhanced mitochondrial function. Consistently, anti-CD96 therapy effectively eliminates PTCs in preclinical models. We also engineered epithelial cell adhesion molecule (EpCAM)-targeted human chimeric antigen receptor (CAR)-T cells deficient in CD96 expression, which robustly target PTCs and demonstrate remarkable therapeutic potential against CRC. Overall, our study uncovers CD96 as a previously unrecognized axis of vulnerability within the PTC-driven microenvironment, offering a promising avenue to enhance CRC therapeutic outcomes.