Cited by 67Cancer Immunotherapy and BiomarkersImmunotherapy and Immune ResponsesRadiopharmaceutical Chemistry and Applications

Low-dose irradiation of the gut improves the efficacy of PD-L1 blockade in metastatic cancer patients

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Chen, Jianzhou, Levy, Antonin, Tian, Ai-Ling, Huang, Xuehan, Cai, Guoxin, Fidelle, Marine, Rauber, Conrad, Ly, Pierre +53 more·2025·Cancer Cell

Abstract

The mechanisms governing the abscopal effects of local radiotherapy in cancer patients remain an open conundrum. Here, we show that off-target intestinal low-dose irradiation (ILDR) increases the clinical benefits of immune checkpoint inhibitors or chemotherapy in eight retrospective cohorts of cancer patients and in tumor-bearing mice. The abscopal effects of ILDR depend on dosimetry (≥1 and ≤3 Gy) and on the metabolic and immune host-microbiota interaction at baseline allowing CD8 + T cell activation without exhaustion. Various strains of Christensenella minuta selectively boost the anti-cancer efficacy of ILDR and PD-L1 blockade, allowing emigration of intestinal PD-L1-expressing dendritic cells to tumor-draining lymph nodes. An interventional phase 2 study provides the proof-of-concept that ILDR can circumvent resistance to first- or second-line immunotherapy in cancer patients. Prospective clinical trials are warranted to define optimal dosimetry and indications for ILDR to maximize its therapeutic potential.

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Crossref · 10.1016/j.ccell.2025.02.010

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  • Baseline abundance of Christensenellaceae was associated with better long-term outcomes from PD-1 blockade plus low-dose abdominal irradiation.

    “The prevalence of Christensenellaceae family members at baseline correlated with favorable long-term effects of PD-1 blockade combined with low-dose abdominal irradiation 94”
  • Preclinical experiments suggested that the Christensenellaceae effect was mediated by migration of intestinal mature dendritic cells, which are enriched in immunoregulatory molecules, to distant tumor-draining lymph nodes, leading to infiltration of non-exhausted CD8+ T cells into tumors.

    “Preclinical experimentation suggested that this effect of Christensenellaceae was mediated by the migration of intestinal mature dendritic cells (enriched in immunoregulatory molecules) to distant tumor-draining lymph nodes, which then triggered tumor infiltration by non-exhausted CD8 + T cells 94”

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Authors
Chen, J., Levy, A., Tian, A.-L., Huang, X., Cai, G., Fidelle, M., Rauber, C., Ly, P., Pizzato, E., Sitterle, L., Piccinno, G., Liu, P., Durand, S., Mao, M., Zhao, L., Iebba, V., Felchle, H., Mallard de La Varende, A.-L., Fischer, J. C., Thomas, S., Greten, T. F., Jones, J. C., Monge, C., Demaria, S., Formenti, S., Belluomini, L., Dionisi, V., Massard, C., Blanchard, P., Robert, C., Quevrin, C., Lopes, E., Clémenson, C., Mondini, M., Meziani, L., Zhan, Y., Zeng, C., Cai, Q., Morel, D., Sun, R., Laurent, P.-A., Mangoni, M., Di Cataldo, V., Arilli, C., Trommer, M., Wegen, S., Neppl, S., Riechelmann, R. P., Camandaroba, M. P., Neto, E. S., Fournier, P.-E., Segata, N., Holicek, P., Galluzzi, L., Buqué, A., Alves Costa Silva, C., Derosa, L., Kroemer, G., Chen, C., Zitvogel, L., & Deutsch, E.
Affiliations
  • Inserm (FR)
  • Cancer Hospital of Shantou University Medical College (CN)
  • University of Trento (IT)
  • Institut Gustave Roussy (FR)
  • National Institutes of Health (US)
  • Weill Cornell Medicine (US)
  • University of Verona (IT)
  • University of Florence (IT)
  • Azienda Ospedaliero-Universitaria Careggi (IT)
  • University of Cologne (DE)
  • AC Camargo Hospital (BR)
  • Méditerranée Infection Foundation (FR)
  • Fox Chase Cancer Center (US)
Corresponding author
  • Chen, Chuangzhen
  • Zitvogel, Laurence
Venue
Cancer Cell
Publisher
Elsevier BV
Published
2025-03
Volume
43
Issue
3
Pages
361-379.e10
ISSN
1535-6108 (ISSN-L)
OpenAlex
W4408290455
Cited by
67
References
90
Citations by year
2026: 45 · 2025: 22
FWCI
27.75
Type
journal article
Language
en
Open access
Locations
  • Cancer Cell (publishedVersion, cc-by-nc-nd)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • HAL (submittedVersion, cc-by-nc-nd)
  • ArTS Archivio della ricerca di Trieste (University of Trieste https://www.units.it/) (submittedVersion, cc-by-nc-nd)
  • Florence Research (University of Florence) (submittedVersion)
  • Institutional Research Information System (Università degli Studi di Trento) (submittedVersion, cc-by-nc-nd)
Funders
  • Amgen
  • AstraZeneca
  • Sanofi
  • F. Hoffmann-La Roche
  • Shantou University
  • Innovative Research Group Project of the National Natural Science Foundation of China
  • Seerave Foundation
  • Equipex
  • BeiGene
  • European Commission (101095604, 825410, HORIZON2020, ERC-2021-ADG)
  • Deutsche Forschungsgemeinschaft (SFB1371, 395357507)
  • Agence Nationale de la Recherche (ANR-21-RHUS-0005, ANR18, ANR-21-RHUS-0017, ANR-18-IDEX-0001)
  • Institut National de la Santé et de la Recherche Médicale (ANR-18-IDEX-0001)
  • National Natural Science Foundation of China
  • Natural Science Foundation of Guangdong Province
  • Università degli Studi di Trento
  • Fondation ARC pour la Recherche sur le Cancer
  • Ligue Contre le Cancer (17563)
  • Université de Bourgogne
  • Astellas Pharma
  • Deutsche Krebshilfe (70113964)
  • Institut National Du Cancer (INCa-DGOS-INSERM-6043)
  • European Society for Medical Oncology
  • Friedrich Naumann Stiftung
  • Universität zu Köln
  • Institut Gustave-Roussy
  • Direction Générale de l’offre de Soins
  • Shantou University Medical College
  • PharmaMar
  • Ono Pharmaceutical
  • Université de Paris (ANR-18- IDEX-0001, 18-IDEX-0001)
  • Institut National de Recherche pour l'Agriculture, l'Alimentation et l'Environnement
  • National Institutes of Health (-0001, R01‐grant)
  • Genentech
  • EMD Serono
  • Labex Immuno-Oncology ((ANR-18-IDEX-0001))
  • National Cancer Institute (CA274291, ZIABC011503, U54CA274291, ZIABC011343, R01CA271915)
  • MSDAVENIR
  • HORIZON EUROPE European Research Council (101052444)
  • CHIST-ERA
Topics
  • Health Sciences › Medicine › Oncology › Cancer Immunotherapy and Biomarkers
  • Life Sciences › Immunology and Microbiology › Immunology › Immunotherapy and Immune Responses
  • Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Radiopharmaceutical Chemistry and Applications
Keywords
low-dose radiation, abscopal effect, immune checkpoint inhibitors, PD-L1 blockade, metastatic cancer, gut microbiota, Christensenella minuta, CD8+ T cell activation, T cell exhaustion, dendritic cells, tumor-draining lymph nodes, immunotherapy resistance, combination chemotherapy, radiation dosimetry, host-microbiota interactions
MeSH terms
Gastrointestinal Microbiome, Immune Checkpoint Inhibitors, Aged, Animals, Female, Humans, Immunotherapy, Intestines, Male, Mice, Inbred C57BL, Middle Aged, Neoplasm Metastasis, Neoplasms, Retrospective Studies, CD8-Positive T-Lymphocytes, Mice, B7-H1 Antigen

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