Department of Cutaneous Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.
Department of Medicine, University of Pittsburgh Medical Center and Hillman Cancer Center, Pittsburgh, PA, USA.
J Natl Cancer Inst. 2023 Nov 8;115(11):1278-1293. doi: 10.1093/jnci/djad118.
Immunotherapy combinations are being investigated to expand the benefit of immune checkpoint blockade across many cancer types. Radiation combinations, in particular using stereotactic body radiotherapy, are of keen interest because of underlying mechanistic rationale, safety, and availability as a standard of care in certain cancers. In addition to direct tumor cytotoxicity, radiation therapy has immunomodulatory effects such as induction of immunogenic cell death, enhancement of antigen presentation, and expansion of the T-cell receptor repertoire as well as recruitment and increased activity of tumor-specific effector CD8+ cells. Combinations of radiation with cytokines and/or chemokines and anti-programmed death 1 and anticytotoxic T-lymphocyte antigen 4 therapies have demonstrated safety and feasibility, as well as the potential to improve long-term outcomes and possibly induce out of irradiated field or abscopal responses. Novel immunoradiotherapy combinations represent a promising therapeutic approach to overcome radioresistance and further enhance systemic immunotherapy. Potential benefits include reversing CD8+ T-cell exhaustion, inhibiting myeloid-derived suppressor cells, and reversing M2 macrophage polarization as well as decreasing levels of colony-stimulating factor-1 and transforming growth factor-β. Here, we discuss current data and mechanistic rationale for combining novel immunotherapy agents with radiation therapy.
免疫疗法组合正在被研究,以扩大免疫检查点阻断在许多癌症类型中的获益。放射治疗组合,特别是使用立体定向体放射治疗,因其潜在的机制原理、安全性以及在某些癌症中作为标准治疗的可用性而备受关注。除了直接的肿瘤细胞毒性外,放射治疗还具有免疫调节作用,如诱导免疫原性细胞死亡、增强抗原呈递以及扩大 T 细胞受体库,以及招募和增加肿瘤特异性效应 CD8+细胞的活性。放射治疗与细胞因子和/或趋化因子以及抗程序性死亡 1 和抗细胞毒性 T 淋巴细胞抗原 4 治疗的联合已被证明具有安全性和可行性,并且有可能改善长期结果并可能诱导照射野外或远隔效应。新型免疫放射治疗组合代表了一种有前途的治疗方法,可以克服放射抵抗并进一步增强全身免疫治疗。潜在的益处包括逆转 CD8+T 细胞衰竭、抑制髓样来源的抑制细胞以及逆转 M2 巨噬细胞极化,以及降低集落刺激因子-1 和转化生长因子-β的水平。在这里,我们讨论了将新型免疫治疗药物与放射治疗相结合的现有数据和机制原理。
J Natl Cancer Inst. 2023-11-8
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