Combining radiotherapy and immune checkpoint inhibitors in metastatic cancers: a 25-year review of safety outcomes by the ENRSO Group.

Journal: Cancer metastasis reviews

This scoping review systematically examined the safety and feasibility of combining immune checkpoint inhibitors (ICIs) with radiotherapy (RT) in metastatic cancers. It analyzed 59 studies involving 3,593 patients.

The focus was on grade ≥ 3 adverse events and factors influencing toxicity, such as:

  • Irradiation site
  • Radiation dose
  • Treatment timing

Findings showed the median incidence of severe adverse events ranged from approximately:

  • 9.7–11% for anti-PD-1
  • 10.5–19% for anti-PD-L1
  • 20–25% for anti-CTLA-4 agents

Importantly, adding RT to ICI did not significantly increase toxicity compared to ICI alone.

Overall, concurrent use of ICIs and RT appears to be a safe approach in metastatic cancer without requiring immunotherapy discontinuation or regimen modification during radiation.

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