It is an interesting study indeed and the small sample size still yields tantalizing data. The combination that was used, ie radiotherapy and FLT3-ligand, is a rational approach. The radiotherapy induces low level cancer cell death which ends up releasing tumor specific antigens. The FLT3-ligand leads to a proliferation of dendritic cells, and in the presence of the released antigens, you would theoretically observe greater numbers of mature antigen presenting cells. This would improve priming for CTLs and, in my opinion, would help to overcome immune suppression caused by CTLA-4 on Tregs. I think you can numerically overwhelm CTLA-4 on Tregs intratumorally with the presence of high densities of mature dendritic cells.
Also, radiotherapy, when used the right way in a very targeted manner, can be a friend to in-situ vaccine approaches. Oncosec's electroporation platform by itself appears to accomplish a similar release of tumor specific antigens; this effect was observed in many of their preclinical datasets. By themselves, radiotherapy and electroporation don't typically accomplish much, but they definitely contribute to the very early stages of the immunity cycle. Without adequate tumor specific antigen release, there wouldn't be much of an immune response. Their recognition is essential for any in-situ cancer vaccine.
The 4-month PFS endpoint seems short, but I imagine disease progression is common within that timeframe for advanced stages of NSCLC.
This is a great find danger - thanks for sharing!
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