Abstract：
OBJECTIVE: In the past decade, immune checkpoint inhibitors (ICIs) have emerged as a treatment option for metastatic breast cancer (BC). More recently, ICIs have been approved in the perioperative setting. This has led to clinical scenarios where radiation therapy (RT) is given concurrently with ICIs. On the other hand, moderate and ultrahypofractionated schedules of RT are being widely adopted in the adjuvant setting, in addition to an increased use of metastasis-directed therapy. Furthermore, RT can modulate the tumor microenvironment and induce a systemic response at nonirradiated sites, an \"abscopal effect.\" The amplification of antitumor immune response is used as the rationale behind the concomitant use of ICIs and RT. To date, there is a lack of literature on the optimal sequence, timing, dose/fractionation schema, and treated RT volumes with ICIs in patients with BC, especially in the era of ultrahypofractionation.
METHODS: We conducted a systematic review to delineate the reported treatment details, safety, and efficacy of combining ICI and RT in patients with BC. PubMed, Embase, and Cochrane CENTRAL were searched between 2014 and 2023. Data were extracted to assess the details of ICIs/RT delivery, safety, and efficacy.
RESULTS: Of the 12 eligible studies, 9 involved patients with metastatic BC. Most studies were phase 1/2, had a small sample size (range, 8-28), and were heterogenous in patient population and reported outcomes. The combination was reported to be safe. We identified 1 study in the perioperative setting, which did a posthoc analysis of safety/efficacy of ICIs in the adjuvant setting with receipt and pattern of RT.
CONCLUSIONS: In conclusion, there are limited data on the dose, timing, fractionation, and volumes of RT in both the adjuvant and metastatic setting in BC. Ongoing/future trials should collect and report such data on RT details, whenever RT is used in combination with ICIs.
METHODS: We conducted a systematic review to delineate the reported treatment details, safety, and efficacy of combining ICI and RT in patients with BC. PubMed, Embase, and Cochrane CENTRAL were searched between 2014 and 2023. Data were extracted to assess the details of ICIs/RT delivery, safety, and efficacy.
RESULTS: Of the 12 eligible studies, 9 involved patients with metastatic BC. Most studies were phase 1/2, had a small sample size (range, 8-28), and were heterogenous in patient population and reported outcomes. The combination was reported to be safe. We identified 1 study in the perioperative setting, which did a posthoc analysis of safety/efficacy of ICIs in the adjuvant setting with receipt and pattern of RT.
CONCLUSIONS: In conclusion, there are limited data on the dose, timing, fractionation, and volumes of RT in both the adjuvant and metastatic setting in BC. Ongoing/future trials should collect and report such data on RT details, whenever RT is used in combination with ICIs.
摘要：
目标：在过去的十年中，免疫检查点抑制剂(ICIs)已成为转移性乳腺癌(BC)的治疗选择.最近,ICI已在围手术期获得批准。这导致了与ICI同时进行放射治疗（RT）的临床情况。另一方面,在佐剂设置中，RT的中度和超低分分（HF）时间表被广泛采用，除了增加使用转移定向治疗。此外，RT可以调节肿瘤微环境，并在非照射部位诱导全身反应，\'abscopaleffect\'。抗肿瘤免疫应答的扩增被用作伴随使用ICI和RT的基本原理。迄今为止,缺乏关于最优序列的文献，定时,BC患者的剂量/分割方案和ICIs治疗的RT体积，尤其是在HF时代。
方法：我们进行了系统评价，以描述报告的治疗细节，联合ICI和RT治疗BC患者的安全性和有效性。Pubmed,Embase和CochraneCENTRAL在2014年至2023年之间进行了搜索。提取数据以评估ICI/RT交付的细节，安全性和有效性。
结果：在12项符合条件的研究中，9例涉及转移性BC患者。大多数研究为1/2期，样本量较小（范围8-28），在患者群体和报告的结果中具有异质性。据报道该组合是安全的。我们在围手术期确定了一项研究，在接受和RT模式的情况下，对ICIs在辅助治疗中的安全性/有效性进行了事后分析。
结论：结论：关于剂量的数据有限，定时,分馏,BC中辅助和转移设置中的RT体积。正在进行/未来的试验应收集和报告有关RT细节的数据，每当RT与ICI结合使用时。
方法：我们进行了系统评价，以描述报告的治疗细节，联合ICI和RT治疗BC患者的安全性和有效性。Pubmed,Embase和CochraneCENTRAL在2014年至2023年之间进行了搜索。提取数据以评估ICI/RT交付的细节，安全性和有效性。
结果：在12项符合条件的研究中，9例涉及转移性BC患者。大多数研究为1/2期，样本量较小（范围8-28），在患者群体和报告的结果中具有异质性。据报道该组合是安全的。我们在围手术期确定了一项研究，在接受和RT模式的情况下，对ICIs在辅助治疗中的安全性/有效性进行了事后分析。
结论：结论：关于剂量的数据有限，定时,分馏,BC中辅助和转移设置中的RT体积。正在进行/未来的试验应收集和报告有关RT细节的数据，每当RT与ICI结合使用时。
