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. 2019 May 2;20(9):2173.
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

Rodolfo Chicas-Sett  1 , Ignacio Morales-Orue  2 , Juan Castilla-Martinez  3 , Juan Zafra-Martin  4 , Andrea Kannemann  5 , Jesus Blanco  6 , Marta Lloret  7   8 , Pedro C Lara  9   10
Affiliations

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

Rodolfo Chicas-Sett et al. Int J Mol Sci. .

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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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flow chart of systematic literature search process according to PRISMA statement.
Figure 2
Figure 2
Distribution of weighted mean distant/abscopal response rates according in prospective and retrospective studies in SABR-ICI combination and ICI alone trials.
Figure 3
Figure 3
Distribution of weighted mean progression-free survival (PFS) according in prospective and retrospective studies in SABR-ICI combination.
Figure 4
Figure 4
Distribution of weighted mean overall survival (OS) according in prospective and retrospective studies in SABR-ICI combination and ICI alone studies.
Figure 5
Figure 5
Grade ≥3 Adverse Events in SABR and ICI combination treatment.
See this image and copyright information in PMC

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