Radiotherapy could increase the efficacy of immunotherapy in non-small cell lung cancer

Abstract

BackgroundIn non-small cell lung cancer (NSCLC), immunotherapy is a treatment option in patients without targetable mutations in second and later lines. Nevertheless, there is no validated test that can predict immunotherapy response. Material and MethodsOur study aimed to investigate the effect of radiotherapy (RT) on survival in patients with NSCLC receiving immunotherapy after first-line chemotherapy. Twenty-five patients diagnosed with NSCLC and received immunotherapy after at least one previous chemotherapy line were included in our study. ResultsThe median age of the patients was 61.7 (26.6-81.2) years. 19 (76%) patients were male. 11 (44%) of the patients had received immunotherapy in the second-line and 14 (66%) in ≥3 lines. Patients had received a median of 5 cycles (1-27) of immunotherapy. RT to immunotherapy interval was 6.4 months (1.0-11.8). Partial response was observed in 12 patients, stable disease in 8 patients, progression in 1 patient, and hyperprogression in 4 patients. Median progression-free survival (PFS) was 4.4 months (95% CI; 3.2-5.6), and median overall survival (OS) was 16.4 months (95% CI; 5.6-27.3). 14 (56%) of the patients had received RT. RT was administered to 12 patients before immunotherapy, and two patients received RT to bones during immunotherapy. The patients who received RT had statistically longer PFS (4.9 vs 3.9 months, p=0.012) and OS (18.7 vs 7.3 months, p=0.023) comparing those without RT. Conclusions Our findings showed that RT significantly improved the survival in patients who received immunotherapy, pointing that RT may have an influential role in immunotherapy response.

Hyperprogressive disease in lung metastases without target lesion progression after durvalumab consolidation therapy: A case report

“…In lung cancer chemotherapy, ICIs are often used for the treatment of lung cancer with metastasis, but they have recently been approved for consolidation therapy after curative chemoradiotherapy for locally advanced unresectable non‐small cell lung cancer 3 . Regarding the relationship between radiotherapy and HPD, Ocak et al reported that radiotherapy may suppress the occurrence of HPD 6 . In addition, reports have shown that radiotherapy can activate the immune system by releasing tumor antigens, 7 and after antigen release, dendritic cells take up the antigens and present them to effector T cells, serving as a bridge for systemic immune responses 8 .…”

“… 3 Regarding the relationship between radiotherapy and HPD, Ocak et al reported that radiotherapy may suppress the occurrence of HPD. 6 In addition, reports have shown that radiotherapy can activate the immune system by releasing tumor antigens, 7 and after antigen release, dendritic cells take up the antigens and present them to effector T cells, serving as a bridge for systemic immune responses. 8 Zhao et al concluded that the induction of sufficient antigen release by radiotherapy helps to suppress the occurrence of HPD.…”