Dosimetric Characterization of an Abscopal Response in a Patient With Oligometastatic Melanoma Undergoing Concurrent Treatment With Pembrolizumab and Stereotactic Body Radiotherapy (SBRT)

Sims‐Mourtada, Jennifer; Casteneda, Serguei; Huang, David; McGlade, J; Shah, Sheel; Romak, Lindsay B.; Raben, Adam; Mourtada, Firas

doi:10.17140/csmmoj-4-121

Cited by 3 publications

(1 citation statement)

References 14 publications

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“…In a recent melanoma case study report, Tsui and NR not reported colleagues [36] had demonstrated that palliative local radiation therapy (24 Gy, 3 fractions) not only controlled the primary tumor growth but also produced regression of metastatic lung lesions suggesting the abscopal effect of radiation therapy. Sims-Mourtada and co-investigators [37] also showed the abscopal effects of radiation in a patient with oligometastatic melanoma undergoing concurrent treatment with pembrolizumab and stereotactic body radiation therapy. Following the combination treatment with radiation plus pembrolizumab, the patient experienced both local as well as a systemic response as evidenced by an out-of-the radiation field improvement.…”

Section: Abscopal Effects In Melanoma/skin Cancermentioning

confidence: 93%

The systemic immunostimulatory effects of radiation therapy producing overall tumor control through the abscopal effect

D’Andrea¹,

Reddy²

2019

J Radiat Oncol

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Objective Emerging studies show that radiation therapy produces an important out of field (distant) effect known as the ''abscopal effect^in nonirradiated tumor sites. The objective of this study was to provide an overview of the current state of knowledge and clinical experience of radiation therapy producing abscopal effects in the management of different types of malignant diseases. Methods Peer-reviewed published clinical evidence on the abscopal effect of radiation therapy was collected using electronic databases such as Medline via PubMed and Google Scholar. The reference lists were searched in the publications that we obtained in an attempt to find additional relevant publications. Non-indexed peer-reviewed journals were manually searched and relevant information was extracted. The search was restricted to English language articles. The clinical data on the abscopal effect of radiation therapy were reviewed and the outcomes have been summarized. Results Currently, only clinical case reports and anecdotes have slowly converted into solid clinical data and interest is building in the field of radiation therapy, specifically on how local radiation can produce the abscopal effects for the management of different types of malignant tumors. Extensive clinical evidence suggests that the radiation therapy induced abscopal antitumor effects are mediated by immune cells such as the T-lymphocytes. This forms a basis for using radiation therapy in combination with immunotherapy to augment the abscopal response rates in cancer patients. Current evidence demonstrates that radiation therapy induces abscopal responses across many tumor types. Conclusion Together, the clinical outcomes from published reports suggest that localized radiation therapy is capable of inducing abscopal effects in a wide variety of malignant tumors. With the advent of novel immunotherapies, the potential for immune activation by radiation defines a novel role for radiation therapy in the treatment of systemic disease. A clinical consideration of the abscopal effects produced by radiation therapy could lead to a revolutionary change in the current management of patients including radiation treatment strategies and immunotherapies for various malignant tumors.

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Section: Abscopal Effects In Melanoma/skin Cancermentioning

confidence: 93%

The systemic immunostimulatory effects of radiation therapy producing overall tumor control through the abscopal effect

D’Andrea¹,

Reddy²

2019

J Radiat Oncol

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Systemic Antitumor Effects and Abscopal Responses in Melanoma Patients Receiving Radiation Therapy

D’Andrea¹,

Reddy²

2020

Oncology

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Background: Malignant melanoma represents the deadliest form of skin cancer with a high tendency to metastasize during the early course of the disease. Radiation therapy has long played a key role in the management of both local and metastatic melanoma. Although local radiation therapy exerts antitumor effects by damaging the cellular DNA, it also induces an important out-of-field (distant) effect known as the “abscopal effect” in nonirradiated sites. Radiation therapy-induced abscopal effects are believed to be mediated by activation and stimulation of the immune system. Objective: To provide a detailed overview of the current state of knowledge and clinical experience of radiation therapy-induced abscopal effects in patients with malignant melanoma. Methods: Using electronic databases such as MEDLINE via PubMed and Google Scholar, a systematic literature review was performed to find published clinical evidence for radiation therapy-induced abscopal effects in patients with malignant melanoma. The clinical data on radiation therapy-induced abscopal effects were reviewed and the outcomes summarized. Results: Clinical evidence of patients with malignant melanoma was gathered using databases from MEDLINE and those findings were summarized. Although the precise mechanism of the abscopal effect of radiation therapy is still not completely understood, evidence suggests that tumor cell destruction by radiation releases tumor antigens that stimulate the immune system of the host to activate the body’s immune effector cells systemically and produce distant non-target antitumor effects. This forms a basis for using the radiation therapy with immunotherapy to augment the abscopal response rates. Conclusions: Current clinical evidence suggests that there is a large potential to enhance the abscopal effect when radiation therapy is combined with immunotherapeutic agents for the treatment of malignant melanoma. Ongoing and planned clinical trials may provide us with a more in-depth understanding of how this combination therapy can be optimally utilized clinically to achieve improved survival outcomes among patients with malignant melanoma.

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Abscopal Effect in Metastatic Melanoma: Generating Clinical Insights From Radiation-Induced Immune Response

Nguyen,

Phan,

Reddy

2024

Cureus

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Despite modern advancements in systemic therapies, melanoma remains a highly malignant cancer, with persistent resistance to therapies such as checkpoint inhibitors and inhibitors of mutated BRAF V600E. Current therapy for targeting metastatic melanoma remains palliative radiation therapy, particularly directly at symptomatic sites. Extraordinarily, few case studies have reported locally targeted radiation resulting in regression of distal non-targeted lesions. This rare phenomenon was coined as the abscopal effect and presents with increasing frequency due to the advancement of systemic therapy. This narrative review attempts to understand the underlying mechanisms behind the abscopal effect through clinical data from 21 melanoma patients reported in 19 case studies. Case identification focused on patients who had progressed on systemic therapy before receiving radiation. Our study observed a mean total Gy of 34 (median total 30 Gy) and mean fractionation Gy of 8 (median fractionation 7.5 Gy) with increased frequency of reported abscopal effects with incorporation of modern systemic immunotherapies. The reviewed cases suggest that combining radiation with immunotherapy may enhance systemic tumor control, though further research is required to better understand the underlying mechanisms and improve treatment outcomes.

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Dosimetric Characterization of an Abscopal Response in a Patient With Oligometastatic Melanoma Undergoing Concurrent Treatment With Pembrolizumab and Stereotactic Body Radiotherapy (SBRT)

Cited by 3 publications

References 14 publications

The systemic immunostimulatory effects of radiation therapy producing overall tumor control through the abscopal effect

The systemic immunostimulatory effects of radiation therapy producing overall tumor control through the abscopal effect

Systemic Antitumor Effects and Abscopal Responses in Melanoma Patients Receiving Radiation Therapy

Abscopal Effect in Metastatic Melanoma: Generating Clinical Insights From Radiation-Induced Immune Response

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