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

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
2
Clinical Oncology, Medical School, Las Palmas University of Gran Canaria, 35001 Las Palmas de Gran Canaria, Spain
3
Department of Oncology, San Roque University Hospital, Calle Dolores de la Rocha 5, 35001 Las Palmas de Gran Canaria, Spain
4
Faculty of Health Sciences, Fernando Pessoa Canarias University, Calle la Juventud S/N, 35450 Las Palmas, Spain
*
Author to whom correspondence should be addressed.
Int. J. Mol. Sci. 2019, 20(9), 2173; https://doi.org/10.3390/ijms20092173
Received: 2 April 2019 / Revised: 23 April 2019 / Accepted: 24 April 2019 / Published: 2 May 2019
(This article belongs to the Special Issue Partnership of Radiotherapy and Immunotherapy)
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. View Full-Text
Keywords: abscopal effect; radiotherapy; immunotherapy; CTLA-4; Anti-PD-1/PD-L1; SABR; ICI; SBRT abscopal effect; radiotherapy; immunotherapy; CTLA-4; Anti-PD-1/PD-L1; SABR; ICI; SBRT
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Chicas-Sett, R.; Morales-Orue, I.; Castilla-Martinez, J.; Zafra-Martin, J.; Kannemann, A.; Blanco, J.; Lloret, M.; Lara, P.C. Stereotactic Ablative Radiotherapy Combined with Immune Checkpoint Inhibitors Reboots the Immune Response Assisted by Immunotherapy in Metastatic Lung Cancer: A Systematic Review. Int. J. Mol. Sci. 2019, 20, 2173.

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