Radiotherapy enhances efficacy of PD-1 inhibitors in advanced hepatocellular carcinoma:A propensity-matched real-world study

Background:To address the need for immunotherapy in patients with advanced primary hepatocellular carcinoma(HCC),combination with radiotherapy(RT)has emerged as a promising strategy.In preclinical studies,irradiated tumors released tumor antigens to synergistically increase the antitumor effect of immunotherapy.Hence,we investigated whether RT enhances the efficacy of anti-programmed death receptor-1(PD-1)inhibitors in advanced HCC in real-world practice.Methods:Between August 2018 and June 2021,172 patients with advanced primary HCC were enrolled in the tertiary center(Zhongshan Hospital of Fudan University);95 were treated with a combination of RT and the inhibitor of PD-1(RT-PD1 cohort),and 77 were administered anti-PD-1 therapy(PD1 cohort).The first cycle of PD-1 inhibitors was administered within 60 days or concurrently with RT.Propensity score matching for bias reduction was used to evaluate the clinical outcomes.Results:Among 71 propensity-matched pairs,median progression-free survival was 5.7 months in the RT-PD1 cohort vs.2.9 months in the PD1 cohort(P<0.001).Median overall survival was 20.9 months in the RT-PD1 cohort vs.11.2 months in the PD1 cohort(P=0.018).Compared with patients in the PD1 cohort,patients in the RT-PD1 cohort had significantly higher objective response rates(40.8%,29/71 vs.19.7%,14/71,P=0.006)and disease control rates(62.0%,44/71 vs.31.0%,22/71,P<0.001).The incidences of toxic effects were not significantly different between the two cohorts.Conclusions:RT plus anti-PD-1 therapy is well tolerated.RT enhances the efficacy of anti-PD-1 therapy in patients with advanced primary HCC by improving survival outcomes without increased toxic effects.

DNA sensing and associated type 1 interferon signaling contributes to progression of radiation-induced liver injury

Liver damage upon exposure to ionizing radiation(IR),whether accidental or therapeutic,can contribute to liver dysfunction.Currently,radiotherapy(RT)is used for various cancers including hepatocellular carcinoma(HCC);however,the treatment dose is limited by radiation-induced liver disease(RILD)with a high mortality rate.Furthermore,the precise molecular mechanisms of RILD remain poorly understood.Here,we investigated RILD pathogenesis using various knockout mouse strains subjected to whole-liver irradiation.We found that hepatocytes released a large quantity of double-stranded DNA(dsDNA)after irradiation.The cGAS-STING pathway in non-parenchymal cells(NPCs)was promptly activated by this dsDNA,causing interferon(IFN)-I production and release and concomitant hepatocyte damage.Genetic and pharmacological ablation of the IFN-I signaling pathway protected against RILD.Moreover,clinically irradiated human peri-HCC liver tissues exhibited substantially higher STING and IFNβexpression than non-irradiated tissues.Increased serum IFNβconcentrations post-radiation were associated with RILD development in patients.These results delineate cGAS-STING induced type 1 interferon release in NPCs as a key mediator of IR-induced liver damage and described a mechanism of innate-immunity-driven pathology,linking cGAS-STING activation with amplification of initial radiation-induced liver injury.

Efficacy and safety of S-1 based adjuvant chemoradiotherapy for resected pancreatic ductal adenocarcinoma with high-risk pathological feature: a prospective, single-arm, interventional study

Objective: It remains unclear whether adjuvant chemoradiotherapy (CRT) improves survival outcome of pancreatic ductal adenocarcinoma (PDAC) patients after surgery. This study aimed to investigate the efficacy and safety of tegafur/gimeracil/oteracil (S-1)-based adjuvant concurrent chemoradiotherapy in resected PDAC patients with defined high-risk pathological features.Methods: We conducted a single-arm, prospective, and interventional study at Zhongshan Hospital Fudan University from December 2012 to December 2019 and the last follow-up was conducted in December 2021. This study was approved by the Ethics Committee of Zhongshan Hospital Fudan University on December 27, 2012 (approval No. B2012-139). Resected PDAC patients with high-risk pathological features, including positive resection margin, pathological T3-4N1-2M0 disease, peripancreatic fat invasion, microvascular invasion, and perineural invasion, were recruited. Primary endpoint was overall survival and secondary endpoints were disease-free survival, treatment toxicity, and 2-, 5-year survival rates.Results: A total of 54 patients were recruited. Mean age was 63.6 years old (±7.2). The distribution of T and N stages were 24.1% for T1, 46.3% for T2, 27.8% for T3, 1.9% for T4, 33.3% for N1, and 11.1% for N2. Seven patients had R1 resection. The median overall survival and disease-free survival were 27.1 and 13.7 months, respectively, while no fatal adverse events were recorded. Subgroup analyses showed differences in survival outcomes among patients with microvascular invasion, different N stages, and preoperative CA 19-9 levels. Further, a Cox proportional hazard model demonstrated associations of lymph node metastases, CA 19-9 level, and microvascular invasion with overall survival and disease-free survival.Conclusion: S-1 -based adjuvant CRT showed promising efficacy and manageable toxicity in resected PDAC patients with highrisk pathological features.

Clinical Diagnosis and Treatment Recommendations for Immune Checkpoint Inhibitor-Associated Myocarditis

Immune checkpoint inhibitors(ICIs)are often beneficial in the treatment of multiple types of malignant tumors.However,ICI-associated myocarditis has introduced new clinical challenges.This report highlights the key clinical issues of ICI-associated myocarditis,such as risk factors,diagnosis and differential diagnosis,clinical classification and treatment,monitoring of outcomes,and restart of treatment.Additionally,practical guidance and suggestions for the diagnosis and treatment of ICI-associated myocarditis are proposed with reference to the relevant consensuses or guidelines and newly published evidence-based studies in China and other countries in combination with clinical experience of physicians from Shanghai,China.

Modern Radiotherapy in the Multidisciplinary Management of Common Cancers

Radiotherapy(RT)is an indispensable treatment for nearly all cancer types.Rapid evolution of technology has progressively increased the safely deliverable radiation dose,minimizing the exposure of uninvolved normal tissue and thus improving the efficacy,safety,and accessibility of radiation therapy.Meanwhile,multidisciplinary team management that aims to define personalized,optimal treatment strategies through shared decision-making between healthcare professionals and patients is a fundamental aspect of high-quality cancer diagnosis and treatment and often includes radiation oncology.How to combine this with other anti-tumor modalities,especially immunotherapy,in the era of modern RT has been increasingly emphasized.Here,in this review,we introduce the innovations in RT technology,and aim to provide an outline of the role of contemporary RT in the multidisciplinary treatment of most common cancers,including non-small cell lung cancer,esophageal cancer,breast cancer,hepatocellular carcinoma,gastric/esophageal-gastric junction cancer,and colorectal cancer,focusing on the main areas of innovation that are conducive to a change toward the personalized application of RT.We also discuss the future research directions for combination with modern RT.