Abstract Radiation therapy (RT) can both stimulate antitumor immunity and induce immunosuppressive responses, complicating its therapeutic efficacy. Data indicate that certain patient subsets—such as those undergoing combination treatment with radiation and immune-oncology drugs and/or targeted therapies may benefit from strategies that target immunosuppression or metastasis-promoting factors. One of the key challenges is the heterogeneous and context-dependent nature of myeloid suppressive states in the tumor microenvironment, which often leads to resistance to RT and immunotherapy. RT has been shown to skew myeloid plasticity towards immune suppression by expanding myeloid-derived suppressor cell (MDSC) populations, increasing their trafficking into tumor tissues, and promoting the development of suppressive macrophage subsets. Targeting myeloid cell plasticity post-RT presents a promising therapeutic strategy. Interventions that block the systemic induction of immunosuppressive myeloid cells to inhibit their trafficking to tumors, or those that promote the conversion of suppressive myeloid cells into anti-tumor populations could enhance the effectiveness of RT. Additionally, radiation-induced proteins that can be inhibited or amplified may provide a potential avenue to overcome the limitations of RT alone, and in combination with immunotherapy. Citation Format: Ralph R. Weichselbaum. Radiotherapy immunotherapy interactions: What determines success or failure?. [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Translating Targeted Therapies in Combination with Radiotherapy; 2025 Jan 26-29; San Diego, CA. Philadelphia (PA): AACR; Clin Cancer Res 2025;31(2_Suppl):Abstract nr IA09
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