Combining Immunotherapy with Radiotherapy for the Treatment of Genitourinary Malignancies

Abhishek A. Solanki, Alberto Bossi, Jason A. Efstathiou, Derrick Lock, Michele Mondini, Rishab Ramapriyan, James Welsh, Josephine Kang

Research output: Contribution to journalReview articlepeer-review

20 Scopus citations

Abstract

Context: Immunotherapy drugs, particularly checkpoint inhibitors, have recently been approved by the Food and Drug Administration for various malignancies. Preclinical and early clinical data show that combining these agents with radiotherapy may produce an even more potent antitumor effect in the treatment of cancer. Objective: To describe the rationale, available data, and emerging data on the use of combined immunotherapy and radiation therapy in the setting of genitourinary (GU) malignancies. Evidence acquisition: We performed a search of primary studies from PubMed/Medline that included combinations of the search terms “radiation therapy,” “radiotherapy,” “abscopal effect,” “immunotherapy,” “combined,” and “combination.” Evidence synthesis: Preclinical and clinical data support both immune-stimulating and immune-suppressing effects of radiotherapy. Preclinical and clinical studies investigating the combination of radiotherapy with immunotherapy, primarily in the setting of non-GU malignancies, have suggested efficacy and tolerability. Early randomized trials combining radiotherapy and immunotherapy have demonstrated success in lung cancer. Although a trial investigating combined immunotherapy and radiotherapy use for prostate cancer did not clearly improve survival, trials are ongoing in multiple GU malignancies to identify synergy between immunotherapy and radiotherapy. Several practical and technical questions remain about the optimal combination of radiotherapy and immunotherapy. Conclusions: Preclinical and clinical trials show that the combination of the immunotherapy and radiation therapy has the potential to provide a synergistic effect in treating cancer, including GU malignancies, although more work is needed to uncover the mechanism and determine the optimal delivery of this treatment. Patient summary: This paper reviews evidence that immunotherapy drugs can be given together with radiation therapy to improve outcomes in cancers of the genitourinary tract. We find promising initial results and raise important questions that need to be answered before this type of treatment can be utilized successfully. We reviewed the preclinical and clinical evidence that immunotherapy combined with radiotherapy may synergistically improve local and systemic responses in genitourinary malignancies. Emerging data are promising, and several practical and technical details in treatment delivery need to be studied further.

Original languageEnglish (US)
Pages (from-to)79-87
Number of pages9
JournalEuropean Urology Oncology
Volume2
Issue number1
DOIs
StatePublished - Feb 2019

Keywords

  • Abscopal effect
  • Bladder cancer
  • Checkpoint inhibitors
  • Immunotherapy
  • Kidney cancer
  • Prostate cancer
  • Radiotherapy

ASJC Scopus subject areas

  • General Medicine

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