Cited by 276Cancer Immunotherapy and BiomarkersImmunotherapy and Immune ResponsesT-cell and B-cell Immunology

Radiation therapy and anti-tumor immunity: exposing immunogenic mutations to the immune system

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Lhuillier, Claire, Rudqvist, Nils-Petter, Elemento, Olivier, Formenti, Silvia C., Demaria, Sandra·2019·Genome Medicine

Abstract

The expression of antigens that are recognized by self-reactive T cells is essential for immune-mediated tumor rejection by immune checkpoint blockade (ICB) therapy. Growing evidence suggests that mutation-associated neoantigens drive ICB responses in tumors with high mutational burden. In most patients, only a few of the mutations in the cancer exome that are predicted to be immunogenic are recognized by T cells. One factor that limits this recognition is the level of expression of the mutated gene product in cancer cells. Substantial preclinical data show that radiation can convert the irradiated tumor into a site for priming of tumor-specific T cells, that is, an in situ vaccine, and can induce responses in otherwise ICB-resistant tumors. Critical for radiation-elicited T-cell activation is the induction of viral mimicry, which is mediated by the accumulation of cytosolic DNA in the irradiated cells, with consequent activation of the cyclic GMP-AMP synthase (cGAS)/stimulator of interferon (IFN) genes (STING) pathway and downstream production of type I IFN and other pro-inflammatory cytokines. Recent data suggest that radiation can also enhance cancer cell antigenicity by upregulating the expression of a large number of genes that are involved in the response to DNA damage and cellular stress, thus potentially exposing immunogenic mutations to the immune system. Here, we discuss how the principles of antigen presentation favor the presentation of peptides that are derived from newly synthesized proteins in irradiated cells. These concepts support a model that incorporates the presence of immunogenic mutations in genes that are upregulated by radiation to predict which patients might benefit from treatment with combinations of radiotherapy and ICB.

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Authors
Lhuillier, C., Rudqvist, N.-P., Elemento, O., Formenti, S. C., & Demaria, S.
Affiliations
Weill Cornell Medicine (US)
Corresponding author
Demaria, Sandra
Venue
Genome Medicine
Published
2019-06-20
Volume
11
Issue
1
Pages
40-40
ISSN
1756-994X (ISSN-L)
OpenAlex
W2952477280
Cited by
276
References
96
Citations by year
2026: 34 · 2025: 28 · 2024: 36 · 2023: 51 · 2022: 41 · 2021: 47 · 2020: 35 · 2019: 4
FWCI
3.03
Type
journal article
Language
en
Open access
Locations
  • Genome Medicine (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
  • National Cancer Institute (R01CA198533, R01CA201246)
  • American Association for Cancer Research (18-40-43-LHUI)
Topics
  • Health Sciences › Medicine › Oncology › Cancer Immunotherapy and Biomarkers
  • Life Sciences › Immunology and Microbiology › Immunology › Immunotherapy and Immune Responses
  • Life Sciences › Immunology and Microbiology › Immunology › T-cell and B-cell Immunology
Keywords
radiotherapy, antitumor immunity, immune checkpoint blockade, neoantigens, tumor mutational burden, viral mimicry, cytosolic DNA, cGAS-STING pathway, type I interferon, DNA damage response, antigen presentation, tumor-specific T cells, cancer immunotherapy
MeSH terms
Animals, Antigens, Neoplasm, Humans, Mutation, Neoplasms, Radiotherapy, Antigen Presentation

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