Abstract
Background: Several immunotherapy (IT) agents are FDA approved for treatment of melanoma and non-small-cell lung cancer (NSCLC). The addition of stereotactic radiosurgery (SRS) or stereotactic body radiation therapy (SBRT) to immunotherapy looks promising. A systematic review was conducted to evaluate the possible synergistic effects of immune checkpoints inhibitors (ICIs) and stereotactic radiation therapy in melanoma and NSCLC. Materials and methods: Pubmed databases from January 2010 to December 2020 were reviewed to identify English language studies reporting control of local and abscopal effect of the combination of ICI-SBRT/SRS in metastatic NSCLC and melanoma cancer. The inclusion criteria were followed according to PICO criteria. Results: Thirty-nine articles were included of the 2141 initial results. The reported rates for local control were 16.5–100% and 40–94% in brain and extracerebral metastases, respectively. Distant/abscopal response rates were 1–45% in extracerebral metastases. Abscopal effect could not be evaluated in brain metastases because it was not reported in studies. Treatments were well tolerated with few grade 4 toxicities and no grade 5. Conclusions: The combined treatment of ICI-SBRT/SRS achieves high local control and non-negligible abscopal response in patients with extracerebral metastases, with its benefit in cerebral metastases being more controversial. Clinical trials are needed to better characterize the potential synergism.
Highlights
Local radiation therapy (RT) is known to modulate the immune response [1,2]
In the tables presented below, the results are separated according to the target location of the radiation therapy, that is, according to whether the local treatment with stereotactic body radiation therapy (SBRT)/stereotactic radiosurgery (SRS)
The difficulty of extravasating the blood–brain barrier could lead to a potential inequality in the systemic effect produced by the brain SRS compared to that produced by the SBRT on extracerebral lesions
Summary
The development of immunotherapeutic drugs has led to a rapid growth of publications that have attempted to elucidate the potential synergistic effects of the combined treatment of immunotherapy with radiation therapy. This combination is known as immunoradiotherapy [3,4]. A systematic review was conducted to evaluate the possible synergistic effects of immune checkpoints inhibitors (ICIs) and stereotactic radiation therapy in melanoma and NSCLC. Materials and methods: Pubmed databases from January 2010 to December 2020 were reviewed to identify English language studies reporting control of local and abscopal effect of the combination of ICI-SBRT/SRS in metastatic NSCLC and melanoma cancer. Treatments were well tolerated with few grade 4 toxicities and no grade
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