Radiotherapy and the immune system: More than just immune suppression

• Published in: Stem cells (Dayton, Ohio) Ohio), 2021-09, Vol.39 (9), p.1155-1165
• Main Authors: Rückert, Michael, Flohr, Ann‐Sophie, Hecht, Markus, Gaipl, Udo S.
• Format: Article
• Language: English
• Subjects: Antitumor activity; Cancer; cancer stem cells; Cell death; clinical translation; Clinical trials; Combined Modality Therapy; DNA damage; Humans; immune checkpoints; Immune response; Immune System; immunogenicity; Immunology; Immunostimulation; Immunosuppression; Immunosuppression Therapy; Immunotherapy; Ionizing radiation; Neoplasms - radiotherapy; Radiation therapy; Radiotherapy; Schedules; Solid tumors; Stem cells; Tumor cells; Tumor Microenvironment; Tumors
• ISSN: 1066-5099; 1549-4918
• DOI: 10.1002/stem.3391

Radiotherapy (RT) is still one of the standard cancer therapies, with up to two third of all cancer patients with solid tumors being irradiated in the course of their disease. The aim of using ionizing radiation in fractionated treatment schedules was always to achieve local tumor control by inducing DNA damage which can be repaired by surrounding normal tissue but leads to cell death in tumor cells. Meanwhile, it is known that RT also has immunological effects reshaping the tumor microenvironment. Nevertheless, RT alone often fails to elicit potent antitumor immune responses as these effects can be immunostimulatory as well as immunosuppressive. Here, we discuss how immunotherapies can be exploited in combined therapies to boost RT‐induced antitumor immune responses or to counteract preexisting and RT‐mediated immunosuppression to improve local and systemic tumor control. Furthermore, we highlight some parameters of radioimmunotherapies (RITs) which are under investigation for potential optimizations and how RIT approaches are tested in first phases II and III trials. Finally, we discuss how RT might affect normal and cancer stem cells. The tumor microenvironment, A, can be modulated by radiotherapy (RT) through the induction of immunogenic cell death, B, leading to the priming of cytotoxic T lymphocytes, C. Combinations of RT with immunotherapies, such as immune checkpoint inhibitors counteracting immunosuppression, D, and tumor vaccines or cytokines boosting antitumor immune responses, E, might improve local tumor control and elicit abscopal effects, F.