Abstract
CAR T-cell therapy has revolutionized the treatment approach to patients with relapsed/refractory hematologic malignancies; however, there continues to be opportunity for improvement in treatment toxicity as well as response durability. Radiation therapy can play an important role in combined modality treatments for some patients undergoing CAR T-cell therapy in various clinical settings. In this review, we discuss the current evidence for RT in the setting of CAR T-cell therapy for patients with hematologic malignancies and propose potential opportunities for future investigation of RT and CAR T-cell treatment synergy. Future research frontiers include investigation of hypotheses including radiation priming of CAR T-cell mediated death, pre-CAR T-cell tumor debulking with radiation therapy, and selection of high risk patients for early radiation salvage after CAR T cell therapy.
Highlights
Chimeric antigen receptor (CAR) T-cell therapy has transformed our approach to patients with relapsed/refractory (R/R) aggressive lymphomas, with multiple therapies that have achieved high response rates and notable durable disease remissions in patients with otherwise dismal outcomes
While most patients with diffuse large B-cell lymphoma (DLBCL) respond to frontline immunochemotherapy based regimens [typically rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP)], roughly 30–40% of patients are refractory to primary therapy or develop relapsed disease [1, 2]
We propose that radiation therapy may have an important future role in tumor debulking, pre-infusion conditioning, and post-infusion rescue of residual or resistant disease
Summary
Chimeric antigen receptor (CAR) T-cell therapy has transformed our approach to patients with relapsed/refractory (R/R) aggressive lymphomas, with multiple therapies that have achieved high response rates and notable durable disease remissions in patients with otherwise dismal outcomes. Radiation therapy (RT) may be a valuable treatment modality that, when optimally combined with CAR T-cell therapy, could offer enhanced tumor control and reduced toxicity. We discuss the current evidence for RT in the setting of CAR T-cell therapy for patients with hematologic malignancies and propose potential opportunities for future investigation of RT and CAR T-cell treatment synergy
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