# Radiotherapy + immunotherapy

Source: https://onco.cc/pairings/radiation-plus-io/  
OnCo record `radiation-plus-io` (Pairing). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Radiation turns the irradiated tumour into a vaccine; immunotherapy spreads the response.

## Summary

This combination pairs SBRT / SABR (stereotactic radiotherapy) and other radiotherapy with Immune checkpoint inhibitors: radiation turns the irradiated tumour into a vaccine and immunotherapy spreads the response. Radiation induces immunogenic cell death, cGAS-STING innate sensing, MHC upregulation and antigen release, and PD-L1 rises afterwards, which checkpoint blockade counters. Phase 3 trials are positive in consolidation settings, notably PACIFIC (Durvalumab after chemoradiation in Non-small-cell lung cancer, with overall survival benefit), KEYNOTE-A18 in Cervical cancer and NRG/RTOG trials. The Abscopal effect with SBRT plus immunotherapy is real but inconsistent, with PEMBRO-RT positive and other trials negative, so timing, dose and site matter.

## Fields

- Kind: Pairing
- Last checked: 2026-09-04
- Pairs: SBRT / SABR (stereotactic radiotherapy) + Immune checkpoint inhibitors
- Type: combination
- Rationale: Radiation induces immunogenic cell death, cGAS-STING signalling, MHC upregulation, and antigen release; PD-L1 rises after radiation, which checkpoint blockade counters.
- Evidence: Phase 3 positive in consolidation settings; abscopal effect less consistent.

## Sources

- ADRIATIC: durvalumab after chemoradiotherapy for limited-stage small-cell lung cancer (New England Journal of Medicine 2024): https://doi.org/10.1056/NEJMoa2404873

## Connected records

- cancers: [Cervical cancer](https://onco.cc/cancers/cervical/), [Non-small-cell lung cancer](https://onco.cc/cancers/nsclc/), [Small-cell lung cancer](https://onco.cc/cancers/sclc/)
- drugs: [Durvalumab](https://onco.cc/drugs/durvalumab/), [Pembrolizumab](https://onco.cc/drugs/pembrolizumab/)
- pathways: [cGAS-STING innate sensing](https://onco.cc/pathways/cgas-sting/)
- terms: [Abscopal effect](https://onco.cc/terms/abscopal-effect/)
- technologies: [Immune checkpoint inhibitors](https://onco.cc/technologies/checkpoint-inhibitor/), [SBRT / SABR (stereotactic radiotherapy)](https://onco.cc/technologies/sbrt/)
- pairings: [PD-1 blockade + chemoradiation (locally advanced cervical cancer)](https://onco.cc/pairings/io-plus-crt-cervical/)
- ideas: [A neutral platform trial for radiotherapy plus immunotherapy combinations](https://onco.cc/ideas/idea-fund-rt-io-platform/), [An oncology patent pool for combination trials across companies](https://onco.cc/ideas/idea-fund-combination-patent-pool/), [Pick the radiation dose that switches the immune alarm on, not off](https://onco.cc/ideas/idea-bio2-radiotherapy-sting-fractionation/)

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