Radiotherapy induces responses of lung cancer to CTLA-4 blockade

SC Formenti, NP Rudqvist, E Golden, B Cooper… - Nature medicine, 2018 - nature.com
SC Formenti, NP Rudqvist, E Golden, B Cooper, E Wennerberg, C Lhuillier…
Nature medicine, 2018nature.com
Focal radiation therapy enhances systemic responses to anti-CTLA-4 antibodies in
preclinical studies and in some patients with melanoma,–, but its efficacy in inducing
systemic responses (abscopal responses) against tumors unresponsive to CTLA-4 blockade
remained uncertain. Radiation therapy promotes the activation of anti-tumor T cells, an effect
dependent on type I interferon induction in the irradiated tumor,–. The latter is essential for
achieving abscopal responses in murine cancers. The mechanisms underlying abscopal …
Abstract
Focal radiation therapy enhances systemic responses to anti-CTLA-4 antibodies in preclinical studies and in some patients with melanoma, –, but its efficacy in inducing systemic responses (abscopal responses) against tumors unresponsive to CTLA-4 blockade remained uncertain. Radiation therapy promotes the activation of anti-tumor T cells, an effect dependent on type I interferon induction in the irradiated tumor, –. The latter is essential for achieving abscopal responses in murine cancers. The mechanisms underlying abscopal responses in patients treated with radiation therapy and CTLA-4 blockade remain unclear. Here we report that radiation therapy and CTLA-4 blockade induced systemic anti-tumor T cells in chemo-refractory metastatic non-small-cell lung cancer (NSCLC), where anti-CTLA-4 antibodies had failed to demonstrate significant efficacy alone or in combination with chemotherapy,. Objective responses were observed in 18% of enrolled patients, and 31% had disease control. Increased serum interferon-β after radiation and early dynamic changes of blood T cell clones were the strongest response predictors, confirming preclinical mechanistic data. Functional analysis in one responding patient showed the rapid in vivo expansion of CD8 T cells recognizing a neoantigen encoded in a gene upregulated by radiation, supporting the hypothesis that one explanation for the abscopal response is radiation-induced exposure of immunogenic mutations to the immune system.
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