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Invited Commentary
July 11, 2019

Radiotherapy and Immunotherapy—Shining Further Together

Author Affiliations
  • 1Department of Radiation Medicine, Department of Cell, Developmental and Cancer Biology, Oregon Health & Science University, Portland
  • 2Department of Radiation Oncology and Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California
JAMA Oncol. 2019;5(9):1291-1292. doi:10.1001/jamaoncol.2019.1448

How far that little candle throws his beams!

William Shakespeare, The Merchant of Venice

Major advances in the planning and delivery of high-dose radiotherapy have emerged in the past 2 decades, including the development of stereotactic ablative radiotherapy (SABR). Stereotactic ablative radiotherapy permits the safe delivery of ablative radiotherapy doses to small-volume targets in sites as diverse as the lung, liver, brain, and other organs. It is now widely accepted as an effective alternative primary therapy for early-stage non–small cell lung cancer (NSCLC) in patients who are suboptimal candidates for surgical resection. The past decade also has seen the advent of modern immunotherapy and the beginning of another revolution in oncology. Initial successes in patients with metastatic melanoma and renal cell carcinoma with blockade of cytotoxic T-lymphocyte antigen-4 and programmed cell death 1 (PD-1) checkpoints have resulted in large-scale proliferation of clinical trials of immunotherapy alone and with other treatment modalities to treat virtually every tumor histology. The indications for PD-1/programmed cell death ligand 1 (PD-L1) blockade now apply to most patients with metastatic NSCLC either as single agents in patients with PD-L1–expressing tumors most likely to respond to treatment or combined with cytotoxic chemotherapy.1