ArticleClinical and translational radiation oncology2026
Clinical efficacy of anti-PD-1 immunotherapy with localized non-ablative irradiation against metastatic lymph node in patients with metastatic gastric cancer.
Article in Clinical and translational radiation oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Cancer immunotherapy combining radiotherapy and anti-PD-1 therapy is a promising treatment strategy. However, the optimal method of radiotherapy to combine with anti-PD-1 therapy has not yet been established. We investigated the clinical efficacy of combinatorial immunotherapy with nivolumab and localized non-ablative irradiation against metastatic lymph node (Nivo-lRT_mLN) in patients with metastatic gastric cancer (m-GC). Materials and Methods: This exploratory study included 16 patients with m-GC and nivolumab was administered after non-ablative irradiation, 22.5 Gy/5fractions, on one metastatic lymph node measuring 2.0 cm or larger. We evaluated the immunological characteristics associated with the therapeutic efficacy of Nivo-lRT_mLN by multiplex analysis of cytokines, T cell receptor repertoire and flow cytometric analysis using peripheral blood samples. Results: More than 80% (13 out of 16) of patients had more than 5 metastases and 75% (12 out of 16) of patients had metastases in more than 2 organs. Rate of complete response (CR), partial response (PR), and stable disease (SD) in Nivo-lRT_mLN were 18.7%, 18.7%, and 25.0%. Median survival time was 10.3 months and 4 patients survived for more than five years without recurrence. Before treatment, IL-1ra level was significantly lower and frequency of CD8(+)CD45RO(+)CD27(+)CD127(+) T cells was significantly higher in non-progressors (CR/PR/SD) compared to progressors (PD/NE) and the high group with frequency of CD8(+)CD45RO(+)CD27(+)CD127(+) T cells had significantly better overall survival (OS) than the low group (p = 0.0081). The time-dependent ROC AUC at both the level of IL-1ra and frequency of CD8(+)CD45RO(+)CD27(+)CD127(+) T cells significantly predict OS (p = 0.0193 and p = 0.0442). Conclusions: These preliminary findings indicated that localized non-ablative irradiation against metastatic lymph node has a potential to enhance the clinical efficacy of anti-PD-1 immunotherapy in patients with m-GC, and IL-1ra level and frequency of CD8(+)CD45RO(+)CD27(+)CD127(+) T cells in peripheral blood before treatment may be candidate biomarkers to predict clinical efficacy of Nivo-lRT_mLN.
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