Radiotherapy and Immunotherapy—Shining Further Together
Ce dossier présente deux essais de phase II, l'un évaluant l'intérêt, du point de vue de la survie sans progression, d'ajouter le pembrolizumab à un traitement localisé ablatif (chirurgie, radiothérapie stéréotaxique) chez les patients atteints d'un cancer du poumon non à petites cellules avec oligométastases (Nombre de patients : 51 ; âge médian : 64 ans), l'autre évaluant, du point de vue du taux de réponse globale, l'intérêt d'une radiothérapie stéréotaxique avant le pembrolizumab chez les patients atteints d'un cancer du poumon non à petites cellules de stade avancé (Nombre de patients : 92 ; âge médian : 62 ans)
Major advances in the planning and delivery of high-dose radiotherapy have emerged in the past 2 decades, including the development of stereotactic ablative radiotherapy (SABR). Stereotactic ablative radiotherapy permits the safe delivery of ablative radiotherapy doses to small-volume targets in sites as diverse as the lung, liver, brain, and other organs. It is now widely accepted as an effective alternative primary therapy for early-stage non–small cell lung cancer (NSCLC) in patients who are suboptimal candidates for surgical resection. The past decade also has seen the advent of modern immunotherapy and the beginning of another revolution in oncology. Initial successes in patients with metastatic melanoma and renal cell carcinoma with blockade of cytotoxic T-lymphocyte antigen-4 and programmed cell death 1 (PD-1) checkpoints have resulted in large-scale proliferation of clinical trials of immunotherapy alone and with other treatment modalities to treat virtually every tumor histology. The indications for PD-1/programmed cell death ligand 1 (PD-L1) blockade now apply to most patients with metastatic NSCLC either as single agents in patients with PD-L1–expressing tumors most likely to respond to treatment or combined with cytotoxic chemotherapy.
JAMA Oncology , commentaire, 2018