Ipi-critical responses.

This morning’s news is coming to you live from #ASTRO2017. Not surprisingly, there is a lot of buzz around here about the interactions of immunotherapies and radiation. The landmark PACIFIC trial published earlier this month reported remarkable responses with durvalumab (PD-L1 inhibitor) following definitive chemoradiation for NSCLC...in provocative contrast to much less impressive results with durvalumab sans radiation. Yesterday’s clinical trials session included initial reporting (presentation no: LBA-5) from MD Anderson of a phase II trial of ipilimumab (CTLA-4 inhibitor) in combination with liver and/or lung stereotactic ablative radiation (SABR). What was clear: the addition of SABR to ipi among this well-followed group of 100 patients did not result in toxicity rates above and beyond those seen historically with ipi alone. What was less clear: SABR optimal dosing and timing (sequential to or concurrent with ipi). What was exciting: the response rate of two-thirds among NSCLC patients and the observations of intriguing abscopal effects. What we concluded: the highly-hyped but occasionally disappointing results of immunotherapies are likely (and complicatedly) related to interactions with other treatment modalities, and we play a crucial part.