{"entity":{"id":"radiation-plus-io","kind":"pairing","name":"Radiotherapy + immunotherapy","aka":[],"tldr":"Radiation turns the irradiated tumour into a vaccine; immunotherapy spreads the response.","summary":"This combination pairs SBRT / SABR (stereotactic radiotherapy) and other radiotherapy with Immune checkpoint inhibitors: radiation turns the irradiated tumour into a vaccine and immunotherapy spreads the response. Radiation induces immunogenic cell death, cGAS-STING innate sensing, MHC upregulation and antigen release, and PD-L1 rises afterwards, which checkpoint blockade counters. Phase 3 trials are positive in consolidation settings, notably PACIFIC (Durvalumab after chemoradiation in Non-small-cell lung cancer, with overall survival benefit), KEYNOTE-A18 in Cervical cancer and NRG/RTOG trials. The Abscopal effect with SBRT plus immunotherapy is real but inconsistent, with PEMBRO-RT positive and other trials negative, so timing, dose and site matter.","asOf":"2026-09-04","links":[{"label":"ADRIATIC: durvalumab after chemoradiotherapy for limited-stage small-cell lung cancer (New England Journal of Medicine 2024)","url":"https://doi.org/10.1056/NEJMoa2404873"}],"tags":[],"related":[],"cancers":["nsclc","cervical","sclc"],"sections":[],"technologies":[],"targets":[],"drugs":["durvalumab","pembrolizumab"],"companies":[],"institutions":[],"pathways":["cgas-sting"],"terms":["abscopal-effect"],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"a":"sbrt","b":"checkpoint-inhibitor","rationale":"Radiation induces immunogenic cell death, cGAS-STING signalling, MHC upregulation, and antigen release; PD-L1 rises after radiation, which checkpoint blockade counters.","evidence":"Phase 3 positive in consolidation settings; abscopal effect less consistent.","pairingType":"combination"},"route":"/pairings/radiation-plus-io/","neighbours":{"cancer":[{"id":"cervical","kind":"cancer","name":"Cervical cancer","route":"/cancers/cervical/"},{"id":"nsclc","kind":"cancer","name":"Non-small-cell lung cancer","route":"/cancers/nsclc/"},{"id":"sclc","kind":"cancer","name":"Small-cell lung cancer","route":"/cancers/sclc/"}],"drug":[{"id":"durvalumab","kind":"drug","name":"Durvalumab","route":"/drugs/durvalumab/"},{"id":"pembrolizumab","kind":"drug","name":"Pembrolizumab","route":"/drugs/pembrolizumab/"}],"pathway":[{"id":"cgas-sting","kind":"pathway","name":"cGAS-STING innate sensing","route":"/pathways/cgas-sting/"}],"term":[{"id":"abscopal-effect","kind":"term","name":"Abscopal effect","route":"/terms/abscopal-effect/"}],"technology":[{"id":"checkpoint-inhibitor","kind":"technology","name":"Immune checkpoint inhibitors","route":"/technologies/checkpoint-inhibitor/"},{"id":"sbrt","kind":"technology","name":"SBRT / SABR (stereotactic radiotherapy)","route":"/technologies/sbrt/"}],"pairing":[{"id":"io-plus-crt-cervical","kind":"pairing","name":"PD-1 blockade + chemoradiation (locally advanced cervical cancer)","route":"/pairings/io-plus-crt-cervical/"}],"idea":[{"id":"idea-fund-rt-io-platform","kind":"idea","name":"A neutral platform trial for radiotherapy plus immunotherapy combinations","route":"/ideas/idea-fund-rt-io-platform/"},{"id":"idea-fund-combination-patent-pool","kind":"idea","name":"An oncology patent pool for combination trials across companies","route":"/ideas/idea-fund-combination-patent-pool/"},{"id":"idea-bio2-radiotherapy-sting-fractionation","kind":"idea","name":"Pick the radiation dose that switches the immune alarm on, not off","route":"/ideas/idea-bio2-radiotherapy-sting-fractionation/"}]}}