Combined radiation- and immune checkpoint-inhibitor-induced pneumonitis – The challenge to predict and detect overlapping immune-related adverse effects from evolving laboratory biomarkers and clinical imaging
The risk of overlapping pulmonary toxicity induced by thoracic radio(chemo)therapy and immune checkpoint inhibitor therapy in the treatment of patients suffering from non-small cell lung cancer (NSCLC) is one important challenge in successful radioimmunotherapy. In the present opinion we highlight f...
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| Format: | Article |
| Language: | English |
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Elsevier
2023-05-01
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| Series: | Neoplasia: An International Journal for Oncology Research |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1476558623000179 |
| _version_ | 1797851326695079936 |
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| author | Nika Guberina Florian Wirsdörfer Martin Stuschke Verena Jendrossek |
| author_facet | Nika Guberina Florian Wirsdörfer Martin Stuschke Verena Jendrossek |
| author_sort | Nika Guberina |
| collection | DOAJ |
| description | The risk of overlapping pulmonary toxicity induced by thoracic radio(chemo)therapy and immune checkpoint inhibitor therapy in the treatment of patients suffering from non-small cell lung cancer (NSCLC) is one important challenge in successful radioimmunotherapy. In the present opinion we highlight factors that we find important to be considered before treatment initiation, during the treatment sequence, and after treatment completion combined or sequential application of radio(chemo)therapy and immune checkpoint inhibitor therapy. A major aim is to optimize the therapeutic index and to avoid immune related adverse effects. The goals in the future will be focused not only on identifying patients already in the pretreatment phase who could benefit from this complex treatment, but also in identifying patients, who are most likely to have higher grade toxicity. In this respect, proper assessment of clinical performance status, monitoring for the presence of certain comorbidities, evaluation of laboratory parameters such as TGF-α and IL-6 levels, human leukocyte antigens (HLA), and consideration of other potential biomarkers which will evolve in near future are essential. Likewise, the critical parameters must be monitored during the treatment phase and follow-up care to detect potential side effects in time. With the help of high-end imaging which is already used on a daily basis in image guided radiotherapy (IGRT) for intensity modulated radiotherapy (IMRT), its advanced form volumetric modulated arc therapy (VMAT), and adaptive radiation therapy (ART), clinically relevant changes in lung tissue can be detected at an early stage of disease. Concurrent radiotherapy and immunotherapy requires a special focus on adverse events, particularly of the lung, but, when properly approached and applied, it may offer new perspectives for patients with locally advanced NSCLC to be seriously considered as a curative option. |
| first_indexed | 2024-04-09T19:16:06Z |
| format | Article |
| id | doaj.art-c34d213539f941d7b741de8f79b3cde9 |
| institution | Directory Open Access Journal |
| issn | 1476-5586 |
| language | English |
| last_indexed | 2024-04-09T19:16:06Z |
| publishDate | 2023-05-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Neoplasia: An International Journal for Oncology Research |
| spelling | doaj.art-c34d213539f941d7b741de8f79b3cde92023-04-06T06:10:31ZengElsevierNeoplasia: An International Journal for Oncology Research1476-55862023-05-0139100892Combined radiation- and immune checkpoint-inhibitor-induced pneumonitis – The challenge to predict and detect overlapping immune-related adverse effects from evolving laboratory biomarkers and clinical imagingNika Guberina0Florian Wirsdörfer1Martin Stuschke2Verena Jendrossek3Department of Radiation Therapy, West German Cancer Center, University of Duisburg-Essen, University Hospital Essen, GermanyInstitute of Cell Biology (Cancer Research), University of Duisburg-Essen, University Hospital Essen, GermanyDepartment of Radiation Therapy, West German Cancer Center, University of Duisburg-Essen, University Hospital Essen, GermanyInstitute of Cell Biology (Cancer Research), University of Duisburg-Essen, University Hospital Essen, Germany; Corresponding author at: Institute of Cell Biology (Cancer Research), University Hospital Essen, Essen, Virchowstrasse 173, 45147 Essen, Germany.The risk of overlapping pulmonary toxicity induced by thoracic radio(chemo)therapy and immune checkpoint inhibitor therapy in the treatment of patients suffering from non-small cell lung cancer (NSCLC) is one important challenge in successful radioimmunotherapy. In the present opinion we highlight factors that we find important to be considered before treatment initiation, during the treatment sequence, and after treatment completion combined or sequential application of radio(chemo)therapy and immune checkpoint inhibitor therapy. A major aim is to optimize the therapeutic index and to avoid immune related adverse effects. The goals in the future will be focused not only on identifying patients already in the pretreatment phase who could benefit from this complex treatment, but also in identifying patients, who are most likely to have higher grade toxicity. In this respect, proper assessment of clinical performance status, monitoring for the presence of certain comorbidities, evaluation of laboratory parameters such as TGF-α and IL-6 levels, human leukocyte antigens (HLA), and consideration of other potential biomarkers which will evolve in near future are essential. Likewise, the critical parameters must be monitored during the treatment phase and follow-up care to detect potential side effects in time. With the help of high-end imaging which is already used on a daily basis in image guided radiotherapy (IGRT) for intensity modulated radiotherapy (IMRT), its advanced form volumetric modulated arc therapy (VMAT), and adaptive radiation therapy (ART), clinically relevant changes in lung tissue can be detected at an early stage of disease. Concurrent radiotherapy and immunotherapy requires a special focus on adverse events, particularly of the lung, but, when properly approached and applied, it may offer new perspectives for patients with locally advanced NSCLC to be seriously considered as a curative option.http://www.sciencedirect.com/science/article/pii/S1476558623000179Pulmonary toxicityPneumonitisImmune-related adverse effectsImmune checkpoint inhibitor-induced lung injuryRadiation-induced lung injury |
| spellingShingle | Nika Guberina Florian Wirsdörfer Martin Stuschke Verena Jendrossek Combined radiation- and immune checkpoint-inhibitor-induced pneumonitis – The challenge to predict and detect overlapping immune-related adverse effects from evolving laboratory biomarkers and clinical imaging Neoplasia: An International Journal for Oncology Research Pulmonary toxicity Pneumonitis Immune-related adverse effects Immune checkpoint inhibitor-induced lung injury Radiation-induced lung injury |
| title | Combined radiation- and immune checkpoint-inhibitor-induced pneumonitis – The challenge to predict and detect overlapping immune-related adverse effects from evolving laboratory biomarkers and clinical imaging |
| title_full | Combined radiation- and immune checkpoint-inhibitor-induced pneumonitis – The challenge to predict and detect overlapping immune-related adverse effects from evolving laboratory biomarkers and clinical imaging |
| title_fullStr | Combined radiation- and immune checkpoint-inhibitor-induced pneumonitis – The challenge to predict and detect overlapping immune-related adverse effects from evolving laboratory biomarkers and clinical imaging |
| title_full_unstemmed | Combined radiation- and immune checkpoint-inhibitor-induced pneumonitis – The challenge to predict and detect overlapping immune-related adverse effects from evolving laboratory biomarkers and clinical imaging |
| title_short | Combined radiation- and immune checkpoint-inhibitor-induced pneumonitis – The challenge to predict and detect overlapping immune-related adverse effects from evolving laboratory biomarkers and clinical imaging |
| title_sort | combined radiation and immune checkpoint inhibitor induced pneumonitis the challenge to predict and detect overlapping immune related adverse effects from evolving laboratory biomarkers and clinical imaging |
| topic | Pulmonary toxicity Pneumonitis Immune-related adverse effects Immune checkpoint inhibitor-induced lung injury Radiation-induced lung injury |
| url | http://www.sciencedirect.com/science/article/pii/S1476558623000179 |
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