Immunotherapy and Radiation therapy Sequencing in Breast Cancer: A Systematic Review
Abstract
PURPOSE
In the past decade, immune checkpoint inhibitors (ICIs) have emerged as a treatment option for metastatic breast cancer (BC). More recently, ICIs have been approved in the perioperative setting. This has led to clinical scenarios where radiation therapy (RT) is given concurrently with ICIs. On the other hand, moderate- and ultra-hypofractionated (HF) schedules of RT are being widely adopted in the adjuvant setting, in addition to an increased use of metastasis-directed therapy. Furthermore, RT can modulate the tumor microenvironment and induce a systemic response at non-irradiated sites, 'abscopal effect'. The amplification of anti-tumor immune response is used as the rationale behind the concomitant use of ICIs and RT. To date, there is a lack of literature on the optimal sequence, timing, dose/fractionation schema and treated RT volumes with ICIs in patients with BC, especially in the era of HF.
METHODS AND MATERIALS
We conducted a systematic review to delineate the reported treatment details, safety and efficacy of combiningICI and RT in patients with BC. Pubmed, Embase and Cochrane CENTRAL were searched up between 2014-2023. Data was extracted to assess the details of ICIs/RT delivery, safety and efficacy.
RESULTS
Of the twelve eligible studies, nine involved patients with metastatic BC. Most studies were phase 1/2, had a small sample size (range 8-28) and were heterogenous in patients' population and reported outcomes. The combination was reported to be safe. We…
How strong is the evidence?
Evidence Hub reads this as a systematic review. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid.
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