Poly-metastatic.

This op-ed from MDACC recommends a much bolder approach to radioimmunotherapy when attempting to elicit the legendary abscopal effect. The comment is borne out of frustration with the subdued results of myriad early-stage clinical trials assessing the added effectiveness of combining immune checkpoint inhibitors with high-doses of radiation, often (80% of the time) to a single site. The underlying theory of such potential synergy is rather simple: an irradiated tumor should express more tumor antigens. In this context, the authors’ argument is also quite simple: given the tremendous complexities of our multi-layered immune systems, it’s probably worth trying to increase the load and variety of tumor antigens by radiating most or even all metastatic sites. TBL: Why should any radiation attempt to induce tumor antigens for checkpoint inhibitor sensitization not aim to treat as much gross disease as safely possible? | Brooks, Nat Rev Clin Oncol 2018