Cure Alveolar Soft Part Sarcoma International (iCureASPS)

The Role of Radiation Oncology in Immuno‐Oncology

Abstract


Despite the promising efficacy of immunotherapy in some patients, many other patients are resistant. The synergistic effect of radiotherapy (RT) in combination with immunotherapy reported in case reports and clinical trials has piqued the interest of radiologists in investigating the underlying mechanisms and efficacy of the combination in preclinical and clinical trials. To date, the reported data are limited to small‐sized samples, trials lacking a comparison arm, and trials using diverse immunotherapies, various radiation doses, and fractionations. There are just a few studies comparing the efficacy of immunotherapy and radiotherapy to that of conventional therapies or different combinations. Radiologists should design and conduct clinical trials wisely to confirm the efficacy of the combination, particularly the abscopal effect, identify the best combination of various immunotherapeutic drugs and different radiation models for patients, identify the best sequence of the combination, determine the optimal timing of the combination, select the target site and volume, lower adverse effects, and explore predictive models to identify patients who may benefit from the combination therapy. We expect that these clinical trials performed by radiologists will offer definitive evidence for the wide use of the combination of RT and immunotherapy in clinical practice.

Implications for Practice.
This review will provide an update on the use of a combination of radiotherapy and immunotherapy, a cautious interpretation of preliminary results, and future directions for radiologists to perform in clinical trials.



http://theoncologist.alphamedpress.org/ ... 6029b1d0b8



Conclusion

Based on promising preliminary data, the combination of RT and immunotherapy is predicted to be an important treatment model in the future. To date, the reported data are limited to trials with a small sample, a shorter follow‐up period, a lack of a comparison arm, a use of diverse immunotherapies, and various radiation doses and fractionations. A comparison of the efficacy with conventional therapy or with different combinations is difficult. The radiologist should adequately address several questions before the combination is widely used in clinical practice.

First, clinical trials should be conducted using a wise design. Second, the best combination for patients should be chosen from various immunotherapeutic drugs and different radiation models. Third, the best sequence of the combination should be identified to which radiation will be added. Fourth, the prediction model should be established to determine the response to the combination. Fifth, the patient should be assisted in choosing the best and most appropriate treatment from options such as surgery, immunotherapy, chemotherapy, targeted therapy, chemoradiotherapy, and radioimmunotherapy.

Many trials are ongoing or in the design stage. Those well‐designed trials are expected to offer definite evidence that patients will acquire a real benefit from the combination treatment, with fewer adverse effects and at a lower cost.

"Direct and bystander radiation effects: A biophysical model and clinical perspectives"

Abstract


In planning treatment for each new patient, radiation oncologists pay attention to the aspects that they control. Thus their attention is usually focused on volume and dose. The dilemma for the physician is how to protract the treatment in a way that maximizes control of the tumor and minimizes normal tissue injury. The initial radiation-induced damage to DNA may be a biological indicator of the quantity of energy transferred to the DNA. However, until now the biophysical models proposed cannot explain either the early or the late adverse effects of radiation, and a more general theory appears to be required. The bystander component of tumor cell death after radiotherapy measured in many experimental works highlights the importance of confirming these observations in a clinical situation.

Highlights


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The reaction of the cell to DNA damage is to activate DNA repair processes to remove the lesions.
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To be able to predict normal tissue response would have important implications in radiotherapy.
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Non-targeted action could be considered as the immunological response to stress induced by radiation.
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Radiotherapy may not only be a successful local and regional treatment but also a systemic cancer therapy.





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