# Radiotherapy and Immunotherapy--A Future Partnership towards a New Standard
## 4 Radiotherapy and Immunotherapy--From Research to Clinical Practice
The randomized, double-blind, phase 3 trial CheckMate-577 study evaluated the role of nivolumab in stage II-III esophageal and gastroesophageal junction cancer with residual disease after chemoradiotherapy. With an OS of 22.4 months vs. 11 months in favor of the group treated with immunotherapy, the study demonstrates not only the benefit of \begin{table}
\begin{tabular}{c c c c c} \hline \hline
**Type of Cancer** & **Clinical Trial/Case** & **Immunotherapy** & **Radiotherapy** & **Results** \\  & **Report** & **Agent/Regimen** & **Regimen** & **Results** \\ \hline Lung & Case report [30] & Atezolizumab & Whole-brain radiotherapy (WBRT) & Primary tumor and lung metastases \\  & & & 30 Gy in 10 fractions & remission \\ \hline Lung & ABSCOPAL-1 Clinical Trial [9] & Nivolumab one & hypfractionated & \\  & Trial [9] & a month & brachytherapy single & plasma levels of interleukin IL-6, IL-10, \\  & & & Stereotactic body & and IL-17A were \\  & & & radiotherapy (SBRT) & significantly reduced \\  & & & 40–50 Gy in 5 fractions & \\ \hline Lung & NCT04238169 [31] & Toripalimab 240 mg & & \\  & & once every three & SBRT 30–50 Gy in & \\  & & weeks/ bevacizumab & 5 fractions & \\  & & & + toripalimab & \\ \hline Renal cell carcinoma & 4 case reports [32] & Interferon + & SBRT (32 Gy in & \\  & & IL-2/Thalidomide & 4 fractions) & Metastasis response or \\  & & (antiangiogenic agent) & Stereotactic & no new lesions \\  & & 50 mg daily or no & radiosurgery (SRT) & \\  & & systemic treatment & 30 Gy in 2 fractions & \\ \hline Intrahepatic & Case report [33] & Nivolumab at a dose of & SBRT 55 Gy in & recurrent intrahepatic \\ cholangiocarcinoma carcinoma & Case report [33] & 200 mg every 2 weeks & 5 fractions & lesion and the lymph \\  & & for 15 cycles & & node metastases \\ \hline Melanoma and & & & & \\ squamous cell carcinoma of the left & & & & \\ ear, neck, and forehead & Case series [9] & & & Not specified \\ Melanoma & & & 4 cycles of ipilimumab & 27 Gy (no fractionation \\ Squamous cell & & & & \\ cervical cancer & & & regimen specified) & \\ \hline metastatic cutaneous & & & & Postoperative SBRT & Abdomen and chest \\ squamous cell carcinoma & & & 45 Gy in 5 fractions for & tumor regression \\  & & & primary tumor & Complete metabolic \\  & & & & Radiochemotherapy \\ carcinoma & & & (70 Gy) and SBRT on & the larynx, bilateral \\ SCC of larynx & & & & axillary lymph node \\  & & & 21 Gy in 3 fractions & lymph nodes \\ \hline  & & & & \\  & & & & \\ advanced sinonasal & & & & \\ squamous cell carcinoma & & & & \\  & & & & \\  & & & & \\ \hline Malignant melanoma & & & & \\  & & & & \\  & & & & \\  & & & & \\ \hline Melanoma, non-small & & & Median total dose of & \\ cell lung cancer & & & 24 Gy (1–40 Gy) in & \\  & & Moras Oncology & & 3 fractions \\ renal cancer & & & (1–10 fractions) & \\ \hline \hline \end{tabular}
\end{table} 
Table 1: Abscopal effect in clinical practice. nivolumab in association with radio-chemotherapy but also identifies PD-L1 status, tumor histology, and lymph node status as prognostic factors [58]. The non-randomized phase 2 study KEYNOTE-799 enrolled eligible patients with previously untreated unresectable stage IIIA/IIIB/IIIC NSCLC. Depending on the squamous/ non-squamous histology, the chemotherapy regimen included carboplatin and paclitaxel, respectively, and cisplatin pemetrexed to which pembrolizumab and thoracic radiotherapy were associated in both groups. After the concurrent treatment by radio-chemo-immunotherapy, consolidation treatment with 14 additional cycles of pembrolizumab was administered. The results have a relevant ORR of 70.5% and 70.6% for the group with squamous and non-squamous histology, respectively.