Clinical experiences of combining immunotherapy and radiation therapy in non-small cell lung cancer: lessons from melanoma

Radiation therapy (RT) is an essential component of local control for non-small cell lung cancer (NSCLC), but distant failures dictate the poor prognosis of this disease. Until recently, the possibility of using RT as an immunoadjuvant to stimulate a systemic anti-tumor immune response was not a realistic clinical opportunity. The emergence of immune checkpoint blockade as an effective immunotherapy for NSCLC has opened the door for combinatorial approaches involving RT. In melanoma, the body of preclinical evidence combining radiation and immunotherapy buoyed clinical efforts, from which promising results have begun to emerge. Preclinical work combining radiation and immunotherapy indicate similar findings in NSCLC, and clinical efforts are ongoing. Here, we review the rationale, preclinical evidence, ongoing efforts and anticipated challenges of efforts combining radiation and immunotherapy in NSCLC.