Abstract
Lung cancer is one of the main causes of cancer-related mortality worldwide. Over the years, different therapeutic modalities have been adopted depending on tumor stage and patient characteristics, such as surgery, radiotherapy (RT), and chemotherapy. Recently, with the development of immune-checkpoint inhibitors (ICI), the treatment of metastatic and locally advanced non-small cell lung cancer (NSCLC) has experienced a revolution that has resulted in a significant improvement in overall survival with an enhanced toxicity profile. Despite this paradigm shift, most patients present some kind of resistance to ICI. In this setting, current research is shifting towards the integration of multiple therapies, with RT and ICI being one of the most promising based on the potential immunostimulatory synergy of this combination. This review gives an overview of the evolution and current state of the combination of RT and ICI and provides evidence-based data that can improve patient selection. The combination in lung cancer is a safe therapeutic approach that improves local control and progression-free survival, and it has the potential to unleash abscopal responses. Additionally, this treatment strategy seems to be able to re-sensitize select patients that have reached a state of resistance to ICI, further enabling the continuation of systemic therapy.
Highlights
Lung cancer is one of the main causes of cancer-related mortality worldwide
The technological advances of radiotherapy (RT) have allowed for the administration of high doses of radiation with great precision and low rates of toxicity. This was first evidenced with the use of Stereotactic Ablative Radiotherapy (SABR) in early stage inoperable patients, which achieved comparable results to surgery in terms of local control (LC)
Most of the evidence that supports the combination of RT and immune-checkpoint inhibitors (ICI) in lung cancer comes from the experience in metastatic and stage III non-small cell lung cancer (NSCLC), multiple trials are currently assessing the efficacy of this approach in other settings
Summary
Lung cancer is one of the main causes of cancer-related mortality worldwide. The most frequent histological subtype, with up to 84% of cases, is non-small cell lung cancer (NSCLC) [1]. The technological advances of radiotherapy (RT) have allowed for the administration of high doses of radiation with great precision and low rates of toxicity This was first evidenced with the use of Stereotactic Ablative Radiotherapy (SABR) in early stage inoperable patients, which achieved comparable results to surgery in terms of local control (LC). The development of secondary resistances in initially responding patients is a relevant problem In this regard, there is growing evidence that RT is a key contributor to antitumor response, which supports the idea that the immunostimulatory effects of RT can be exploited in order to augment the systemic response to ICI [9]. The aim was to provide information that can improve patient selection in order to maximize the benefit of this treatment approach
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
