Boustani Jihane, Grapin Mathieu, Laurent Pierre-Antoine, Apetoh Lionel, Mirjolet Céline
Department of Radiation Oncology, Unicancer-Georges-Francois Leclerc Cancer Center, Dijon, France.
INSERM, U1231 Dijon, France.
Cancers (Basel). 2019 Jun 20;11(6):860. doi: 10.3390/cancers11060860.
Historically, the 4Rs and then the 5Rs of radiobiology explained the effect of radiation therapy (RT) fractionation on the treatment efficacy. These 5Rs are: Repair, Redistribution, Reoxygenation, Repopulation and, more recently, intrinsic Radiosensitivity. Advances in radiobiology have demonstrated that RT is able to modify the tumor micro environment (TME) and to induce a local and systemic (abscopal effect) immune response. Conversely, RT is able to increase some immunosuppressive barriers, which can lead to tumor radioresistance. Fractionation and dose can affect the immunomodulatory properties of RT. Here, we review how fractionation, dose and timing shape the RT-induced anti-tumor immune response and the therapeutic effect of RT. We discuss how immunomodulators targeting immune checkpoint inhibitors and the cGAS/STING (cyclic GMP-AMP Synthase/Stimulator of Interferon Genes) pathway can be successfully combined with RT. We then review current trials evaluating the RT/Immunotherapy combination efficacy and suggest new innovative associations of RT with immunotherapies currently used in clinic or in development with strategic schedule administration (fractionation, dose, and timing) to reverse immune-related radioresistance. Overall, our work will present the existing evidence supporting the claim that the reactivation of the anti-tumor immune response can be regarded as the 6th R of Radiobiology.
从历史上看,放射生物学的4R以及后来的5R解释了放射治疗(RT)分割对治疗效果的影响。这5R分别是:修复、再分布、再氧合、再增殖,以及最近提出的内在放射敏感性。放射生物学的进展表明,RT能够改变肿瘤微环境(TME)并诱导局部和全身(远隔效应)免疫反应。相反,RT能够增加一些免疫抑制屏障,这可能导致肿瘤放射抗性。分割和剂量会影响RT的免疫调节特性。在此,我们综述了分割、剂量和时间安排如何塑造RT诱导的抗肿瘤免疫反应以及RT的治疗效果。我们讨论了靶向免疫检查点抑制剂和cGAS/STING(环鸟苷酸-腺苷酸合成酶/干扰素基因刺激因子)途径的免疫调节剂如何能够成功地与RT联合使用。然后,我们综述了当前评估RT/免疫疗法联合疗效的试验,并提出RT与目前临床使用或正在研发的免疫疗法的新的创新联合方案,通过策略性的给药方案(分割、剂量和时间安排)来逆转免疫相关的放射抗性。总体而言,我们的工作将展示现有证据支持以下观点:抗肿瘤免疫反应的重新激活可被视为放射生物学的第6个R。