Department of Surgery, School of Medicine, Trinity College Dublin, Dublin, Ireland; Trinity St James' Cancer Institute, St James's Hospital Dublin, Ireland.
Department of Surgery, School of Medicine, Trinity College Dublin, Dublin, Ireland; Trinity St James' Cancer Institute, St James's Hospital Dublin, Ireland.
Cancer Lett. 2021 Apr 1;502:84-96. doi: 10.1016/j.canlet.2020.12.045. Epub 2021 Jan 12.
Immune checkpoint blockade (ICB) has revolutionised the treatment of solid tumours, yet most patients do not derive a clinical benefit. Resistance to ICB is often contingent on the tumour microenvironment (TME) and modulating aspects of this immunosuppressive milieu is a goal of combination treatment approaches. Radiation has been used for over a century in the management of cancer with more than half of all cancer patients receiving radiotherapy. Here, we outline the rationale behind combining radiotherapy with ICB, a potential synergy through mutually beneficial remodelling of the TME. We discuss the pleiotropic effects radiation has on the TME including immunogenic cell death, activation of cytosolic DNA sensors, remodelling the stroma and vasculature, and paradoxical infiltration of both anti-tumour and suppressive immune cell populations. These events depend on the radiation dose and fractionation and optimising these parameters will be key to develop safe and effective combination regimens. Finally, we highlight ongoing efforts that combine radiation, immunotherapy and inhibitors of DNA damage response, which can help achieve a favourable equilibrium between the immunogenic and tolerogenic effects of radiation on the immune microenvironment.
免疫检查点阻断(ICB)彻底改变了实体瘤的治疗方法,但大多数患者并未从中获得临床获益。ICB 的耐药性通常取决于肿瘤微环境(TME),调节这种免疫抑制环境的各个方面是联合治疗方法的目标。放射疗法在癌症治疗中已经使用了一个多世纪,超过一半的癌症患者接受放射治疗。在这里,我们概述了将放射疗法与 ICB 联合使用的基本原理,这是通过 TME 的互惠互利重塑产生的潜在协同作用。我们讨论了放射疗法对 TME 的多效性影响,包括免疫原性细胞死亡、细胞溶质 DNA 传感器的激活、基质和脉管系统的重塑,以及抗肿瘤和抑制性免疫细胞群的反常浸润。这些事件取决于放射剂量和分割,优化这些参数将是开发安全有效的联合方案的关键。最后,我们强调了正在进行的将放射疗法、免疫疗法和 DNA 损伤反应抑制剂结合起来的努力,这有助于在放射疗法对免疫微环境的免疫原性和耐受性影响之间实现有利的平衡。