The interaction between immuno-oncology and immunotherapy is a novel, important area for clinical care research, according to a video from Yale Cancer Center Grand Rounds. Roy H. Decker, MD, PhD, discusses combining radiation and immune checkpoint inhibition in NSCLC specifically in the metastatic setting. 

He is vice chair for clinical research and professor of therapeutic radiology at Yale University School of Medicine.

Radiation activates adaptive and innate immunity which is an important mechanism for the radiation response locally, he said. 

“We think we can exploit this to enhance the systemic anti-tumor effect,” Decker said. “We’ve known for many years that radiation can induce systemic immune responses… Immunotherapy has taken over clinical cancer research in the last decade.”

Decker’s own trial, which began years ago asked: Can the addition of SBRT invigorate an immune response in patients who have progressed on anti-PD-1 therapy? 

Within the expansion cohort, Decker and colleagues studied patients with NSCLC to determine the overall response rate to post-radiation pembrolizumab in those who had already progressed on anti-PD-1 therapy.

Researchers measured the response in lesions that did not receive radiation, in patients who were progressing upon enrollment.

 “We were concerned about the toxicity of combination therapy, but found no dose-limiting toxicity or prohibitive toxicity. Overall, the combination was safe and well tolerated,” Decker added. 

They showed that the addition of radiation to immunotherapy did result in a significant response of at least 6 months for patients who were already progressing. He added that patients that are PD-L1 positive may be the most beneficial to this approach.

“I’m hopeful that our correlative data may show immunological biomarkers that suggest which patients would benefit from the additional immune stimulation of radiation,” Decker said.

Video Source: Youtube
Video Content: Yale Cancer Center Grand Rounds