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Immunotherapy and stereotactic ablative radiotherapy (ISABR): a curative approach?

Nature Reviews Clinical Oncology volume 13, pages 516–524 (2016)Cite this article

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Abstract

Conventional radiotherapy, in addition to its well-established tumoricidal effects, can also activate the host immune system. Radiation therapy modulates tumour phenotypes, enhances antigen presentation and tumour immunogenicity, increases production of cytokines and alters the tumour microenvironment, enabling destruction of the tumour by the immune system. Investigating the combination of radiotherapy with immunotherapeutic agents, which also promote the host antitumour immune response is, therefore, a logical progression. As the spectrum of clinical use of stereotactic radiotherapy continues to broaden, the question arose as to whether the ablative radiation doses used can also stimulate immune responses and, if so, whether we can amplify these effects by combining immunotherapy and stereotactic ablative radiotherapy (SABR). In this Perspectives article, we explore the preclinical and clinical evidence supporting activation of the immune system following SABR. We then examine studies that provide data on the effectiveness of combining these two techniques — immunotherapy and SABR — in an approach that we have termed 'ISABR'. Lastly, we provide general guiding principles for the development of future clinical trials to investigate the efficacy of ISABR in the hope of generating further interest in these exciting developments.

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Figure 1: Antitumour effects of stereotactic ablative radiotherapy (SABR).

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Authors and Affiliations

  1. Sunil Krishnan and Joe Y. Chang are at the Division of Radiation Oncology, Michael B. Bernstein, MD Anderson Cancer Center, Unit 97, 1515 Holcombe Boulevard, Houston, Texas 77030, USA.,

    Michael B. Bernstein, Sunil Krishnan & Joe Y. Chang

  2. James W. Hodge is at the Laboratory of Tumor Immunology and Biology, Center for Cancer Research, National Cancer Institute, Building 10, Room 8B13, Bethesda, Maryland 20892–1750, USA.,

    James W. Hodge

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Correspondence to Joe Y. Chang.

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Bernstein, M., Krishnan, S., Hodge, J. et al. Immunotherapy and stereotactic ablative radiotherapy (ISABR): a curative approach?. Nat Rev Clin Oncol 13, 516–524 (2016). https://doi.org/10.1038/nrclinonc.2016.30

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