Journal
CANCER LETTERS
Volume 541, Issue -, Pages -Publisher
ELSEVIER IRELAND LTD
DOI: 10.1016/j.canlet.2022.215719
Keywords
ES-SCLC; Radiation therapy; Immunotherapy
Categories
Funding
- foundation of National Natural Science Foundation of China [82103632, 81972862, 81627901, 81972863, 82030082]
- foundation of Natural Science Foundation of Shandong [ZR2021QH245, ZR201911040452]
- Key Research and Development Program of Shandong Province [2018GSF118067]
- Academic Promotion Program of Shandong First Medical University [2019RU071]
- Research Unit of Radiation Oncology, Chinese Academy of Medical Sciences [ZR201911040452]
- foun-dation of Natural Science Foundation of Shandong [81972863]
- [2019ZL002]
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Unlike NSCLC, the progression of SCLC is slow. ES-SCLC poses a serious threat to human health with a low 5-year survival rate. Chemotherapy has been the first-line treatment, but anti-PD-L1 checkpoint blockades have emerged as standard therapy. The combination of radiation therapy and immunotherapy in ES-SCLC has limited evidence and requires further prospective trials.
Unlike non-small-cell lung cancer (NSCLC), the progression of small-cell lung cancer (SCLC) is slow. Extensivestage SCLC (ES-SCLC) is a serious threat to human health, with a 5-year survival rate of <7%. Chemotherapy has been the first-line treatment for the past 30 years. The anti-PD-L1 checkpoint blockades durvalumab and atezolizumab have greatly prolonged overall survival and have become the standard first-line therapy for ES-SCLC since the CASPIAN and IMpower133 trials. In the era of chemotherapy, radiation therapy (RT), including thoracic radiation therapy (TRT) and brain radiation therapy (BRT), has shown clinical effects in randomized and retrospective studies on ES-SCLC. RT-immunotherapy has shown exciting synergistic effects in NSCLC. For ESSCLC, the clinical effects of combining TRT/BRT with immunotherapy have not yet been systematically explored. In this review, we found that studies on RT-immunotherapy in ES-SCLC are relatively few and limited to early phase studies focusing on toxicity. The efficacy and safety profiles of early phase studies encourage prospective clinical trials. In this review, we discuss the best population, optimum TRT dose, proper TRT time, and strategies for reducing radiation-induced neurotoxicity. Furthermore, we suggest that biomarkers and patient performance status should be fully assessed before RT-immunotherapy treatment. Prospective trials are needed to provide more evidence for RT-immunotherapy applications in ES-SCLC.
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