Combining precision radiotherapy with molecular targeting and immunomodulatory agents: a guideline by the American Society for Radiation Oncology - 27/04/18

Doi : 10.1016/S1470-2045(18)30096-2

Robert G Bristow, ProfMD ^a,^⁎ , Brian Alexander, MD ^b, Michael Baumann, MD ^c, Scott V Bratman, MD ^a, J Martin Brown, ProfDPhil ^d, Kevin Camphausen, MD ^e, Peter Choyke, MD ^e, Deborah Citrin, MD ^e, Joseph N Contessa, MD ^f, Adam Dicker, ProfMD ^g, David G Kirsch, ProfMD ^h, Mechthild Krause, MD ^c, Quynh-Thu Le, ProfMD ^d, Michael Milosevic, MD ^a, Zachary S Morris, MD ⁱ, Jann N Sarkaria, ProfMD ^j, Paul M Sondel, ProfMD ⁱ, Phuoc T Tran, MD ^k, George D Wilson, ProfMD ^l, Henning Willers, MD ^m, Rebecca K S Wong, ProfMD ^a, Paul M Harari, ProfMD ⁱ
^a Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, ON, Canada
^b Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
^c OncoRay, Dresden, Germany
^d Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
^e Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
^f Department of Therapeutic Radiology, Yale School of Medicine, New Haven, CT, USA
^g Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, PA, USA
^h Department of Radiation Oncology and Department of Pharmacology and Cancer Biology, Duke University Medical Center, Durham, NC, USA
ⁱ Department of Human Oncology, University of Wisconsin, Madison, WI, USA
^j Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
^k Department of Radiation Oncology and Molecular Radiation Sciences, Department of Oncology, and Department of Urology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
^l Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI, USA
^m Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

^*Correspondence to: Prof Robert G Bristow, Manchester Cancer Research Centre, University of Manchester, Manchester, M20 4GJ, UKCorrespondence to: Prof Robert G Bristow, Manchester Cancer Research CentreUniversity of ManchesterManchesterM20 4GJUK

Summary

The practice of radiation oncology is primarily based on precise technical delivery of highly conformal, image-guided external beam radiotherapy or brachytherapy. However, systematic research efforts are being made to facilitate individualised radiation dose prescriptions on the basis of gene-expressssion profiles that reflect the radiosensitivity of tumour and normal tissue. This advance in precision radiotherapy should complement those benefits made in precision cancer medicine that use molecularly targeted agents and immunotherapies. The personalisation of cancer therapy, predicated largely on genomic interrogation, is facilitating the selection of therapies that are directed against driver mutations, aberrant cell signalling, tumour microenvironments, and genetic susceptibilities. With the increasing technical power of radiotherapy to safely increase local tumour control for many solid tumours, it is an opportune time to rigorously explore the potential benefits of combining radiotherapy with molecular targeted agents and immunotherapies to increase cancer survival outcomes. This theme provides the basis and foundation for this American Society for Radiation Oncology guideline on combining radiotherapy with molecular targeting and immunotherapy agents.

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Plan

Introduction

Principles of combined radiotherapy and systemic therapy

Preclinical models testing targeted agents with radiotherapy

Clinical development of targeted therapies with radiotherapy

Precision radiotherapy and targeted agents in metastatic disease

Radioprotection targeting to improve the therapeutic ratio

Combining radiotherapy and immunotherapy

In-situ tumour markers

Systemic tumour markers

Functional imaging

Milestones for success in combining targeted therapies with radiotherapy

Conclusion

Search strategy and selection criteria

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Vol 19 - N° 5

P. e240-e251 - mai 2018 Retour au numéro

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Combining precision radiotherapy with molecular targeting and immunomodulatory agents: a guideline by the American Society for Radiation Oncology - 27/04/18

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