Abstract
Approximately 60%–70% of patients with malignant tumours require radiotherapy. The clinical application of immune checkpoint inhibitors (ICIs), such as anti-PD-1/PD-L1, has revolutionized cancer treatment and greatly improved the outcome of a variety of cancers by boosting host immunity.However, radiotherapy is a double-edged sword for PD-1/PD-L immunotherapy. Research on how to improve radiotherapy efficacy using PD-1/PD-L1 inhibitor is gaining momentum. Various studies have reported the survival benefits of the combined application of radiotherapy and PD-1/PD-L1 inhibitor. To fully exerts the immune activation effect of radiotherapy, while avoiding the immunosuppressive effect of radiotherapy as much as possible, the dose selection, segmentation mode, treatment timing and the number of treatment sites of radiotherapy play a role. Therefore, we aim to review the effect of radiotherapy combined with anti-PD-1/PD-L1 on the immune system and its optimization.
Highlights
Radiotherapy is the main treatment option for tumours
Many pre-clinical data show that radiotherapy combined with immunotherapy enhances tumour killing through the vaccine effect, attraction effect and fragility effect
The synergistic effects of PD-1 and PD-L1 monoclonal antibodies combined with radiotherapy have been confirmed in various preclinical trials
Summary
Radiotherapy is the main treatment option for tumours. Approximately 60%–70% of patients with malignant tumours require radiotherapy. While radiotherapy kills tumour cells, it can damage the immune cells in the irradiated area. Radiotherapy can activate the anti-tumour immune response [7,8,9,10]. Radiotherapy can release a large number of tumour-related antigens by killing tumour cells, inducing an increase in tumour-infiltrating lymphocytes, and enhancing the anti-tumour immune response mediated by CD8+ T cells [9]. Radiotherapy can promote the activation and maturation of dendritic cells It promotes antigen presentation by up-regulating MHC I expression tumour cell surface [7, 8]. It is feasible to combine radiotherapy and immunotherapy based on the immune-stimulating properties of radiotherapy.PD-1/PD-L1 inhibitor has been approved for the treatment of oesophageal, head and neck, melanoma, kidney, bladder, lung cancers and other tumours.
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