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Lansink Rotgerink L, Felchle H, Feuchtinger A, Nefzger SM, Walther CN, Gissibl J, Steiger K, Schmid TE, Heidegger S, Combs SE, Fischer JC. Experimental investigation of skin toxicity after immune checkpoint inhibition in combination with radiation therapy. J Pathol 2022; 258:189-198. [PMID: 35830288 DOI: 10.1002/path.5989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 06/17/2022] [Accepted: 07/11/2022] [Indexed: 11/09/2022]
Abstract
Immune checkpoint inhibitors (ICIs) have revolutionized cancer therapy. However, structured knowledge to mitigate a patient's specific risk of developing adverse events are limited. Nevertheless, there is an exponential growth of clinical studies combining conventional therapies such as radiation therapy (RT) with ICIs. Cutaneous reactions are amongst the most common adverse events after monotherapy with either ICIs or RT. So far, little is known about inter-individual differences in the risk of developing severe tissue toxicity after the combination of RT with ICIs, and the underlying biological mechanisms are ill defined. We used experimental models of RT-induced skin injury to analyze skin toxicity after simultaneous application of ICIs. We compared different RT regimens such as fractionated or stereotactic RT with varying dose intensity. Strikingly, we found that simultaneous application of RT and ICIs did not significantly aggravate acute skin injury in two different mouse strains. Detailed examination of long-term tissue damage of the skin revealed similar signs of epidermal hyperplasia, dermal fibrosis, and adnexal atrophy. In summary, we here present the first experimental study demonstrating excellent safety profiles of concurrent treatment with RT and ICIs. These findings will help to interpret the development of adverse events of the skin after radioimmunotherapy and guide the design of new clinical trials and clinical decision making in individual cases. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Laura Lansink Rotgerink
- Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Department of Radiation Oncology, Munich, Germany
| | - Hannah Felchle
- Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Department of Radiation Oncology, Munich, Germany
| | - Annette Feuchtinger
- Helmholtz Zentrum München - German Research Center for Environmental Health, Research Unit Analytical Pathology, Neuherberg, Germany
| | - Sophie M Nefzger
- Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Department of Radiation Oncology, Munich, Germany
| | - Caroline N Walther
- Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Department of Radiation Oncology, Munich, Germany
| | - Julia Gissibl
- Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Department of Radiation Oncology, Munich, Germany
| | - Katja Steiger
- Technical University of Munich, School of Medicine, Comparative Experimental Pathology, Munich, Germany.,Technical University of Munich, School of Medicine, Institute of Pathology, Munich, Germany.,German Cancer Consortium (DKTK), Partner-site Munich and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Thomas E Schmid
- Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Department of Radiation Oncology, Munich, Germany.,Helmholtz Zentrum München, Institute of Radiation Medicine, 85764, Neuherberg, Germany
| | - Simon Heidegger
- German Cancer Consortium (DKTK), Partner-site Munich and German Cancer Research Center (DKFZ), Heidelberg, Germany.,Technical University of Munich, School of Medicine, Department of Medicine III, Munich, Germany.,Technical University of Munich, Center for Translational Cancer Research (TranslaTUM), School of Medicine, Munich, Germany
| | - Stephanie E Combs
- Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Department of Radiation Oncology, Munich, Germany.,German Cancer Consortium (DKTK), Partner-site Munich and German Cancer Research Center (DKFZ), Heidelberg, Germany.,Helmholtz Zentrum München, Institute of Radiation Medicine, 85764, Neuherberg, Germany
| | - Julius C Fischer
- Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Department of Radiation Oncology, Munich, Germany
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