Combined treatment of non‐small cell lung cancer using radiotherapy and immunotherapy: challenges and updates
Abstract The efficacy of immunotherapy for advanced non‐small cell lung cancer (NSCLC) remains unsatisfactory, as the majority of patients either do not experience an objective response or acquire secondary resistance. As a result, several methods to enhance the systemic efficacy of immunotherapy ha...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2021-11-01
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| Series: | Cancer Communications |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/cac2.12226 |
| _version_ | 1819039817982279680 |
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| author | Shijie Shang Jie Liu Vivek Verma Meng Wu James Welsh Jinming Yu Dawei Chen |
| author_facet | Shijie Shang Jie Liu Vivek Verma Meng Wu James Welsh Jinming Yu Dawei Chen |
| author_sort | Shijie Shang |
| collection | DOAJ |
| description | Abstract The efficacy of immunotherapy for advanced non‐small cell lung cancer (NSCLC) remains unsatisfactory, as the majority of patients either do not experience an objective response or acquire secondary resistance. As a result, several methods to enhance the systemic efficacy of immunotherapy have been investigated, including a large area of active research by combining immunotherapy with radiation therapy (RT). Given the rapidly burgeoning concept of combining immunotherapy and RT for increasing therapeutic benefit, we review the progress in this field thus far and explore further avenues for enhancing this combination. This review commences with a discussion of the only two existing randomized trials (and a pooled analysis) showing that the addition of RT to immunotherapy improves the abscopal response rate, progression‐free survival, and overall survival in metastatic NSCLC patients. We then discussed factors and biomarkers that may be associated with a proportionally greater benefit to additional RT, such as low programmed cell death protein ligand 1 (PD‐L1) status, tumor mutational burden (TMB), and patient's immune function. Next, the implementation of RT to overcome immunotherapy resistance is discussed, including a mechanistic discussion and methods with which these mechanisms could be exploited. Lastly, the emerging role of low‐dose RT is discussed, which may help to overcome inhibitory signals in the tumor stroma that limit T‐cell infiltration. Taken together, given the current state of this rapidly expanding realm, these futuristic strategies may be reflected upon to further enhance the efficacy of immunotherapy for a wider group of patients. |
| first_indexed | 2024-12-21T08:59:14Z |
| format | Article |
| id | doaj.art-1574272ad6444804a89cd9d61272afb1 |
| institution | Directory Open Access Journal |
| issn | 2523-3548 |
| language | English |
| last_indexed | 2024-12-21T08:59:14Z |
| publishDate | 2021-11-01 |
| publisher | Wiley |
| record_format | Article |
| series | Cancer Communications |
| spelling | doaj.art-1574272ad6444804a89cd9d61272afb12022-12-21T19:09:30ZengWileyCancer Communications2523-35482021-11-0141111086109910.1002/cac2.12226Combined treatment of non‐small cell lung cancer using radiotherapy and immunotherapy: challenges and updatesShijie Shang0Jie Liu1Vivek Verma2Meng Wu3James Welsh4Jinming Yu5Dawei Chen6Department of Radiation Oncology Shandong Cancer Hospital Affiliated to Shandong University Jinan Shandong 250117 P. R. ChinaDepartment of Radiation Oncology Laboratory of Radio‐Immunology Cancer Research Center Shandong Cancer Hospital and Institute Shandong First Medical University and Shandong Academy of Medical Sciences Jinan Shandong 250117 P. R. ChinaDepartment of Radiation Oncology The University of Texas MD Anderson Cancer Center 1515 Holcombe Blvd Houston Texas 77030 the United States of AmericaDepartment of Radiation Oncology Laboratory of Radio‐Immunology Cancer Research Center Shandong Cancer Hospital and Institute Shandong First Medical University and Shandong Academy of Medical Sciences Jinan Shandong 250117 P. R. ChinaDepartment of Radiation Oncology The University of Texas MD Anderson Cancer Center 1515 Holcombe Blvd Houston Texas 77030 the United States of AmericaDepartment of Radiation Oncology Shandong Cancer Hospital Affiliated to Shandong University Jinan Shandong 250117 P. R. ChinaDepartment of Radiation Oncology Shandong Cancer Hospital Affiliated to Shandong University Jinan Shandong 250117 P. R. ChinaAbstract The efficacy of immunotherapy for advanced non‐small cell lung cancer (NSCLC) remains unsatisfactory, as the majority of patients either do not experience an objective response or acquire secondary resistance. As a result, several methods to enhance the systemic efficacy of immunotherapy have been investigated, including a large area of active research by combining immunotherapy with radiation therapy (RT). Given the rapidly burgeoning concept of combining immunotherapy and RT for increasing therapeutic benefit, we review the progress in this field thus far and explore further avenues for enhancing this combination. This review commences with a discussion of the only two existing randomized trials (and a pooled analysis) showing that the addition of RT to immunotherapy improves the abscopal response rate, progression‐free survival, and overall survival in metastatic NSCLC patients. We then discussed factors and biomarkers that may be associated with a proportionally greater benefit to additional RT, such as low programmed cell death protein ligand 1 (PD‐L1) status, tumor mutational burden (TMB), and patient's immune function. Next, the implementation of RT to overcome immunotherapy resistance is discussed, including a mechanistic discussion and methods with which these mechanisms could be exploited. Lastly, the emerging role of low‐dose RT is discussed, which may help to overcome inhibitory signals in the tumor stroma that limit T‐cell infiltration. Taken together, given the current state of this rapidly expanding realm, these futuristic strategies may be reflected upon to further enhance the efficacy of immunotherapy for a wider group of patients.https://doi.org/10.1002/cac2.12226immune checkpoint inhibitorsimmunotherapyimmunotherapy combined with radiotherapylow‐dose radiotherapynon‐small cell lung cancerradiotherapy |
| spellingShingle | Shijie Shang Jie Liu Vivek Verma Meng Wu James Welsh Jinming Yu Dawei Chen Combined treatment of non‐small cell lung cancer using radiotherapy and immunotherapy: challenges and updates Cancer Communications immune checkpoint inhibitors immunotherapy immunotherapy combined with radiotherapy low‐dose radiotherapy non‐small cell lung cancer radiotherapy |
| title | Combined treatment of non‐small cell lung cancer using radiotherapy and immunotherapy: challenges and updates |
| title_full | Combined treatment of non‐small cell lung cancer using radiotherapy and immunotherapy: challenges and updates |
| title_fullStr | Combined treatment of non‐small cell lung cancer using radiotherapy and immunotherapy: challenges and updates |
| title_full_unstemmed | Combined treatment of non‐small cell lung cancer using radiotherapy and immunotherapy: challenges and updates |
| title_short | Combined treatment of non‐small cell lung cancer using radiotherapy and immunotherapy: challenges and updates |
| title_sort | combined treatment of non small cell lung cancer using radiotherapy and immunotherapy challenges and updates |
| topic | immune checkpoint inhibitors immunotherapy immunotherapy combined with radiotherapy low‐dose radiotherapy non‐small cell lung cancer radiotherapy |
| url | https://doi.org/10.1002/cac2.12226 |
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