Department of Radiation Oncology, Duke University, Durham, NC.
Department of Radiation Oncology, UC Davis Comprehensive Cancer Center, UC Davis Health, Davis, CA.
Semin Radiat Oncol. 2024 Apr;34(2):243-257. doi: 10.1016/j.semradonc.2024.01.001.
Immunotherapy has shifted the treatment paradigm for many types of cancer. Unfortunately, the most commonly used immunotherapies, such as immune checkpoint inhibitors (ICI), have yielded limited benefit for most types of soft tissue sarcoma (STS). Radiotherapy (RT) is a mainstay of sarcoma therapy and can induce immune modulatory effects. Combining immunotherapy and RT in STS may be a promising strategy to improve sarcoma response to RT and increase the efficacy of immunotherapy. Most combination strategies have employed immunotherapies, such as ICI, that derepress immune suppressive networks. These have yielded only modest results, possibly due to the limited immune stimulatory effects of RT. Combining RT with immune stimulatory agents has yielded promising preclinical and clinical results but can be limited by the toxic nature of systemic administration of immune stimulants. Using intralesional immune stimulants may generate stronger RT immune modulation and less systemic toxicity, which may be a feasible strategy in accessible tumors such as STS. In this review, we summarize the immune modulatory effects of RT, the mechanism of action of various immune stimulants, including toll-like receptor agonists, and data for combinatorial strategies utilizing these agents.
免疫疗法已经改变了许多类型癌症的治疗模式。不幸的是,最常用的免疫疗法,如免疫检查点抑制剂(ICI),对大多数软组织肉瘤(STS)的疗效有限。放射治疗(RT)是肉瘤治疗的主要手段,可诱导免疫调节作用。将免疫疗法和 RT 联合应用于 STS 可能是一种有前途的策略,可以提高肉瘤对 RT 的反应,并提高免疫疗法的疗效。大多数联合策略都采用了免疫疗法,如 ICI,这些免疫疗法可以解除免疫抑制网络的抑制作用。但这些策略只取得了适度的效果,可能是由于 RT 的免疫刺激作用有限。将 RT 与免疫刺激剂联合使用已经产生了有希望的临床前和临床结果,但可能受到全身给予免疫刺激剂的毒性的限制。使用瘤内免疫刺激剂可能会产生更强的 RT 免疫调节作用和更少的全身毒性,这在 STS 等可触及的肿瘤中可能是一种可行的策略。在这篇综述中,我们总结了 RT 的免疫调节作用、各种免疫刺激剂的作用机制,包括 Toll 样受体激动剂,以及利用这些药物的联合策略的数据。
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