Combination Immunotherapy With Radiotherapy in Non-Small Cell Lung Cancer: A Review of Evidence

IF 2.9 2区 医学 Q2 ONCOLOGY Cancer Medicine Pub Date : 2024-11-11 DOI:10.1002/cam4.70402
Justin L. Burr, Kurtis C. Johnson, Joseph J. Carmicheal, Chi Lin, Apar Kishor Ganti
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Abstract

Background

Radiotherapy plays a fundamental role in the treatment of patients with all stages of non-small-cell lung cancer (NSCLC). The emergence of immune checkpoint inhibitors (ICIs) has transformed the standard of care in these patients. The use of ICIs is increasingly utilized in the definitive setting as an adjunct to chemoradiotherapy or surgery and remains a vital component in the treatment of metastatic disease. Despite improvements in patient survival, the use of immunotherapy as monotherapy has shown limited overall response rates with susceptibility to resistance. Radiotherapy has been identified as a viable option to enhance the response rate to ICI and improve outcomes in NSCLC.

Methods

We queried the English PubMed database utilizing variably combined search items including “radiation,” “chemoradiation,” “immune checkpoint,” “immunotherapy,” “stereotactic body radiotherapy,” and “non-small-cell lung”. We additionally searched various acceptable alternative terms for similar keywords such as “radiotherapy” in place of “radiation.” These results were subsequently curated for relevance and impact on current treatment paradigms.

Results

In this review, we discuss preclinical and clinical studies relating to combinatorial use of immunotherapy and radiation in NSCLC. These studies are presented in the context of early-stage, operable stage III, unresectable stage III, and metastatic disease. The majority of the data illustrate promising results regarding the additive or synergistic effects of radiation and immunotherapy with a suggestion that the timing of these treatment modalities is crucial to optimizing outcomes.

Conclusion

While there is now evidence regarding the favorable interplay between radiation and immunotherapy in NSCLC, there remain multiple unanswered questions which are expected to be addressed in ongoing clinical trials.

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非小细胞肺癌放疗联合免疫疗法:证据综述。
背景:放疗在治疗各期非小细胞肺癌(NSCLC)患者中发挥着重要作用。免疫检查点抑制剂(ICIs)的出现改变了这些患者的治疗标准。作为放化疗或手术的辅助手段,ICIs 越来越多地被用于确诊治疗,并且仍然是治疗转移性疾病的重要组成部分。尽管患者的生存率有所提高,但使用免疫疗法作为单一疗法的总体反应率有限,而且容易产生耐药性。放疗被认为是一种可行的选择,可提高对 ICI 的反应率并改善 NSCLC 的治疗效果:我们在英文 PubMed 数据库中查询了包括 "放射"、"化学放疗"、"免疫检查点"、"免疫疗法"、"立体定向体放疗 "和 "非小细胞肺 "在内的不同组合的检索项。此外,我们还搜索了各种可接受的类似关键词的替代词,如用 "放射治疗 "代替 "放射"。随后,我们对这些结果进行了相关性和对当前治疗范例的影响方面的整理:在这篇综述中,我们讨论了有关在 NSCLC 中联合使用免疫疗法和放射疗法的临床前和临床研究。这些研究以早期、可手术 III 期、不可切除 III 期和转移性疾病为背景。大多数数据都表明,放射治疗和免疫治疗的相加或协同作用具有良好的效果,同时也表明,这些治疗方式的时机对于优化疗效至关重要:尽管目前已有证据表明放疗和免疫疗法在治疗 NSCLC 方面具有良好的相互作用,但仍有多个问题尚未解决,这些问题有望在正在进行的临床试验中得到解决。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Cancer Medicine
Cancer Medicine ONCOLOGY-
CiteScore
5.50
自引率
2.50%
发文量
907
审稿时长
19 weeks
期刊介绍: Cancer Medicine is a peer-reviewed, open access, interdisciplinary journal providing rapid publication of research from global biomedical researchers across the cancer sciences. The journal will consider submissions from all oncologic specialties, including, but not limited to, the following areas: Clinical Cancer Research Translational research ∙ clinical trials ∙ chemotherapy ∙ radiation therapy ∙ surgical therapy ∙ clinical observations ∙ clinical guidelines ∙ genetic consultation ∙ ethical considerations Cancer Biology: Molecular biology ∙ cellular biology ∙ molecular genetics ∙ genomics ∙ immunology ∙ epigenetics ∙ metabolic studies ∙ proteomics ∙ cytopathology ∙ carcinogenesis ∙ drug discovery and delivery. Cancer Prevention: Behavioral science ∙ psychosocial studies ∙ screening ∙ nutrition ∙ epidemiology and prevention ∙ community outreach. Bioinformatics: Gene expressions profiles ∙ gene regulation networks ∙ genome bioinformatics ∙ pathwayanalysis ∙ prognostic biomarkers. Cancer Medicine publishes original research articles, systematic reviews, meta-analyses, and research methods papers, along with invited editorials and commentaries. Original research papers must report well-conducted research with conclusions supported by the data presented in the paper.
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