Strategies for overcoming tumor resistance to immunotherapy: Harnessing the power of radiation therapy

Br J Radiol. 2024 Jun 4:tqae100. doi: 10.1093/bjr/tqae100. Online ahead of print.

Abstract

Immune checkpoint inhibitors (ICI) have revolutionized cancer treatment; yet their efficacy remains variable across patients. This review delves into the intricate interplay of tumor characteristics contributing to resistance against ICI therapy and suggests that combining with radiotherapy (RT) holds promise. Radiation, known for its ability to trigger immunogenic cell death and foster an in situ vaccination effect, may counteract these resistance mechanisms, enhancing ICI response and patient outcomes. However, particularly when delivered at high-dose, it may trigger immunosuppressive mechanism and consequent side-effects. Notably, low-dose radiotherapy (LDRT), with its capacity for tumor reprogramming and reduced side effects, offers the potential for widespread application. Preclinical and clinical studies have shown encouraging results in this regard.