Combination of immunotherapy-radiotherapy in non-small cell lung cancer: Reality and perspective

Abstract

The aim of this review was to examine the theoretical, preclinical and clinical bases of the combination radiotherapy immunotherapy in the management of non-small cell lung cancer (NSCLC). Preclinical studies have shown that in addition to its well-established tumoricidal effects, radiotherapy can activate the host immune system and modify the tumor microenvironment. Immunotherapy is currently part of the therapeutic arsenal of the NSCLC given its capacity to restore the host's immune system's ability to recognize and destroy tumor cells. The combination of radiotherapy and immunotherapy seems to be synergistic, particularly with inhibitors of immune checkpoints. This association has become standard in the metastatic stages and especially in consolidation after radiochemotherapy in the locally advanced, unresectable and stable stages. Several questions remain unanswered including the optimal sequence of this combination, the type of radiotherapy (hypo-fractionated or normofractionated), the association of several immunotherapies and the cross-toxicity of the combination. The association of radiotherapy and immunotherapy is a promising treatment.

Keywords

• Radiotherapy
• Immunotherapy
• NSCLC
• Abscopal effect
• Immune checkpoint inhibitors