Radiation therapy and anti-tumor immunity: exposing immunogenic mutations to the immune system
Open accessAbstract
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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Radiotherapy promotes the activation of T cells directed against tumor antigens.
“Radiotherapy promotes the activation of T cells directed against tumor antigens12–15.”
From Gut microbiome diversity is an independent predictor of survival in cervical cancer patients receiving chemoradiation (2021) · cites this paper as [14]
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Human Tumor Antigens Yesterday, Today, and Tomorrow
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Sims, T. T., El Alam, M. B., Karpinets, T. V., Dorta-Estremera, S., Hegde, V. L., Nookala, S., Yoshida-Court, K., Wu, X., Biegert, G. W. G., Delgado Medrano, A. Y., et al. (2021) · Communications Biology · doi:10.1038/s42003-021-01741-x · Cited by 135 · see citing works
Targeting DNA Damage Response and Immune Checkpoint for Anticancer Therapy
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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)
- PMC
- PMC6587285
- 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
- gold
- doi.org
- 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
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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