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Int J Mol Sci. 2019 May 2;20(9). pii: E2173. doi: 10.3390/ijms20092173.

Stereotactic Ablative Radiotherapy Combined with Immune Checkpoint Inhibitors Reboots the Immune Response Assisted by Immunotherapy in Metastatic Lung Cancer: A Systematic Review.

Author information

1
Department of Radiation Oncology, "Dr. Negrín" University Hospital of Gran Canaria, Barranco de la Ballena s/n, 35010 Las Palmas de Gran Canaria, Spain. rchicas@ufm.edu.
2
Department of Radiation Oncology, "Dr. Negrín" University Hospital of Gran Canaria, Barranco de la Ballena s/n, 35010 Las Palmas de Gran Canaria, Spain. ignaciomorue@gmail.com.
3
Department of Radiation Oncology, "Dr. Negrín" University Hospital of Gran Canaria, Barranco de la Ballena s/n, 35010 Las Palmas de Gran Canaria, Spain. juanfe4206@hotmail.com.
4
Department of Radiation Oncology, "Dr. Negrín" University Hospital of Gran Canaria, Barranco de la Ballena s/n, 35010 Las Palmas de Gran Canaria, Spain. jzafra08@gmail.com.
5
Department of Radiation Oncology, "Dr. Negrín" University Hospital of Gran Canaria, Barranco de la Ballena s/n, 35010 Las Palmas de Gran Canaria, Spain. andreakannemann@hotmail.com.
6
Department of Radiation Oncology, "Dr. Negrín" University Hospital of Gran Canaria, Barranco de la Ballena s/n, 35010 Las Palmas de Gran Canaria, Spain. blancosuar@hotmail.com.
7
Department of Radiation Oncology, "Dr. Negrín" University Hospital of Gran Canaria, Barranco de la Ballena s/n, 35010 Las Palmas de Gran Canaria, Spain. mllosae@hotmail.com.
8
Clinical Oncology, Medical School, Las Palmas University of Gran Canaria, 35001 Las Palmas de Gran Canaria, Spain. mllosae@hotmail.com.
9
Department of Oncology, San Roque University Hospital, Calle Dolores de la Rocha 5, 35001 Las Palmas de Gran Canaria, Spain. pedrocarlos.lara@ulpgc.es.
10
Faculty of Health Sciences, Fernando Pessoa Canarias University, Calle la Juventud S/N, 35450 Las Palmas, Spain. pedrocarlos.lara@ulpgc.es.

Abstract

Background: Immune checkpoint inhibitors (ICI) have represented a revolution in the treatment of non-small-cell lung cancer (NSCLC). To improve these results, combined approaches are being tested. The addition of stereotactic ablative radiotherapy (SABR) to ICI seems promising. A systematic review was performed in order to assess the safety and efficacy of SABR-ICI combination. Material and Methods: MEDLINE databases from 2009 to March 3, 2019 were reviewed to obtain English language studies reporting clinical outcomes of the combination of ICI-SABR in NSCLC. 18 out of the 429 initial results fulfilled the inclusion criteria and were selected for review. Results: Eighteen articles, including six prospective studies, describing 1736 patients treated with an ICI-SABR combination fulfilled the selection criteria. The reported mean rates for local control and distant/abscopal response rates were 71% and 41%, respectively. Eleven studies reported progression-free survival and overall survival, with a mean of 4.6 and 12.4 months, respectively. Toxicity rates were consistent with the ones attributable to ICI treatment alone. Conclusions: The ICI-SABR combination has a good safety profile and achieves high rates of local control and greater chances of obtaining abscopal responses than SABR alone, with a relevant impact on PFS. More studies are needed to improve patient selection for an optimal benefit from this approach.

KEYWORDS:

Anti-PD-1/PD-L1; CTLA-4; ICI; SABR; SBRT; abscopal effect; immunotherapy; radiotherapy

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