The role of thoracic consolidative radiotherapy in the setting of immunotherapy in extensive stage small cell lung cancer
The improvement in treatment strategies and outcomes in small cell lung cancer (SCLC) has lagged behind other cancers. The addition of immune checkpoint inhibitors (ICIs), durvalumab and atezolizumab, to the platinum-based chemotherapy in frontline setting has improved the survival in extensive stag...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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SAGE Publishing
2023-08-01
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| Series: | Therapeutic Advances in Medical Oncology |
| Online Access: | https://doi.org/10.1177/17588359231192399 |
| _version_ | 1827856640366346240 |
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| author | Saurav Verma Sympascho Young Alexander V. Louie David Palma Daniel Breadner |
| author_facet | Saurav Verma Sympascho Young Alexander V. Louie David Palma Daniel Breadner |
| author_sort | Saurav Verma |
| collection | DOAJ |
| description | The improvement in treatment strategies and outcomes in small cell lung cancer (SCLC) has lagged behind other cancers. The addition of immune checkpoint inhibitors (ICIs), durvalumab and atezolizumab, to the platinum-based chemotherapy in frontline setting has improved the survival in extensive stage SCLC, (ES-SCLC), albeit modestly, and is now the new standard of care. Prior to advent of immunotherapy into the therapeutic armamentarium in ES-SCLC, consolidative thoracic radiotherapy (TRT) was associated with improved thoracic control and survival outcomes. In the era of ICIs, the role of TRT is not well defined, chiefly because TRT was not incorporated in any immunotherapy trials, secondly due to concerns regarding the increased risks of pneumonitis, and finally uncertain magnitude of benefit with this combined approach. In principle, radiation can increase in the immunogenicity of tumor and hence the activity of immune checkpoint blockade, thereby increasing efficacy both locally and distantly. Such an approach has been promising in non-small cell lung cancer with ICIs improving outcomes after concurrent chemoradiation, but remains unanswered in ES-SCLC. It is, thus, possible that the modest improvement in survival by addition of ICIs to chemotherapy in ES-SCLC can be further improved by the incorporation of consolidative TRT in selected patients. Several early phase trials and retrospective studies have suggested that such an approach may be feasible and safe. Prospective trials are ongoing to answer whether adding radiation therapy to chemoimmunotherapy will improve outcomes in ES-SCLC. |
| first_indexed | 2024-03-12T12:28:41Z |
| format | Article |
| id | doaj.art-67e6bb15e8fe423785ce725d62b22bf6 |
| institution | Directory Open Access Journal |
| issn | 1758-8359 |
| language | English |
| last_indexed | 2024-03-12T12:28:41Z |
| publishDate | 2023-08-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Therapeutic Advances in Medical Oncology |
| spelling | doaj.art-67e6bb15e8fe423785ce725d62b22bf62023-08-29T18:06:00ZengSAGE PublishingTherapeutic Advances in Medical Oncology1758-83592023-08-011510.1177/17588359231192399The role of thoracic consolidative radiotherapy in the setting of immunotherapy in extensive stage small cell lung cancerSaurav VermaSympascho YoungAlexander V. LouieDavid PalmaDaniel BreadnerThe improvement in treatment strategies and outcomes in small cell lung cancer (SCLC) has lagged behind other cancers. The addition of immune checkpoint inhibitors (ICIs), durvalumab and atezolizumab, to the platinum-based chemotherapy in frontline setting has improved the survival in extensive stage SCLC, (ES-SCLC), albeit modestly, and is now the new standard of care. Prior to advent of immunotherapy into the therapeutic armamentarium in ES-SCLC, consolidative thoracic radiotherapy (TRT) was associated with improved thoracic control and survival outcomes. In the era of ICIs, the role of TRT is not well defined, chiefly because TRT was not incorporated in any immunotherapy trials, secondly due to concerns regarding the increased risks of pneumonitis, and finally uncertain magnitude of benefit with this combined approach. In principle, radiation can increase in the immunogenicity of tumor and hence the activity of immune checkpoint blockade, thereby increasing efficacy both locally and distantly. Such an approach has been promising in non-small cell lung cancer with ICIs improving outcomes after concurrent chemoradiation, but remains unanswered in ES-SCLC. It is, thus, possible that the modest improvement in survival by addition of ICIs to chemotherapy in ES-SCLC can be further improved by the incorporation of consolidative TRT in selected patients. Several early phase trials and retrospective studies have suggested that such an approach may be feasible and safe. Prospective trials are ongoing to answer whether adding radiation therapy to chemoimmunotherapy will improve outcomes in ES-SCLC.https://doi.org/10.1177/17588359231192399 |
| spellingShingle | Saurav Verma Sympascho Young Alexander V. Louie David Palma Daniel Breadner The role of thoracic consolidative radiotherapy in the setting of immunotherapy in extensive stage small cell lung cancer Therapeutic Advances in Medical Oncology |
| title | The role of thoracic consolidative radiotherapy in the setting of immunotherapy in extensive stage small cell lung cancer |
| title_full | The role of thoracic consolidative radiotherapy in the setting of immunotherapy in extensive stage small cell lung cancer |
| title_fullStr | The role of thoracic consolidative radiotherapy in the setting of immunotherapy in extensive stage small cell lung cancer |
| title_full_unstemmed | The role of thoracic consolidative radiotherapy in the setting of immunotherapy in extensive stage small cell lung cancer |
| title_short | The role of thoracic consolidative radiotherapy in the setting of immunotherapy in extensive stage small cell lung cancer |
| title_sort | role of thoracic consolidative radiotherapy in the setting of immunotherapy in extensive stage small cell lung cancer |
| url | https://doi.org/10.1177/17588359231192399 |
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