University of Oulu

Jokimäki, A., Hietala, H., Lemma, J. et al. Previous radiotherapy improves treatment responses and causes a trend toward longer time to progression among patients with immune checkpoint inhibitor-related adverse events. Cancer Immunol Immunother 72, 3337–3347 (2023).

Previous radiotherapy improves treatment responses and causes a trend toward longer time to progression among patients with immune checkpoint inhibitor-related adverse events

Saved in:
Author: Jokimäki, Anna1,2,3; Hietala, Henna1; Lemma, Jasmiini4;
Organizations: 1Department of Oncology and Radiotherapy, Oulu University Hospital, Oulu, Finland
2Faculty of Health Sciences, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
3Medical Research Center Oulu, Oulu University Hospital, Oulu, Finland
4Department of Oncology, Comprehensive Cancer Center, Helsinki University Hospital, Helsinki, Finland
5University of Helsinki, Helsinki, Finland
6Faculty of Medicine and Health Technology, Tampere Cancer Center, Tampere University, Tampere, Finland
7Department of Oncology, Tampere University Hospital, Tampere, Finland
8Center of Oncology, Kuopio University Hospital, Kuopio, Finland
9Department of Oncology, Hospital of Central Finland Nova, Jyvaskyla, Finland
10Department of Hematology, Oulu University Hospital, Oulu, Finland
11Science Service Center, Kuopio University Hospital, Kuopio, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 1.3 MB)
Persistent link:
Language: English
Published: Springer Nature, 2023
Publish Date: 2023-11-09


Background: Immune-related adverse events (irAEs) are frequently encountered by patients during immune checkpoint inhibitor (ICI) treatment and are associated with better treatment outcomes. The sequencing of radiotherapy (RT) and ICIs is widely used in current clinical practice, but its effect on survival has remained unclear.

Methods: In a real-world multicenter study including 521 patients who received ICI treatment for metastatic or locally advanced cancer, RT schedules and timing, irAEs, time to progression, overall survival, and treatment responses were retrospectively reviewed.

Results: Patients who received previous RT and developed irAE (RT +/AE +) had the best overall response rate (ORR 44.0%). The ORR was 40.1% in the RT −/AE + group, 26.7% in the RT −/AE − group and 18.3% in the RT + /AE − group (p < 0.001). There was a significantly longer time to progression (TTP) in the RT + /AE + group compared to the RT −/AE − and RT + /AE − groups (log rank p = 0.001 and p < 0.001, respectively), but the trend toward longer TTP in the RT + /AE + group did not reach statistical significance in pairwise comparison to that in the RT −/AE + group. Preceding RT timing and intent had no statistically significant effect on TTP. In a multivariate model, ECOG = 0 and occurrence of irAEs remained independent positive prognostic factors for TTP (HR 0.737; 95% CI 0.582–0.935; p = 0.012, and HR 0.620; 95% CI 0.499–0.769; p < 0.001, respectively).

Conclusions: Better ORR and a trend toward longer TTP were demonstrated for patients with RT preceding ICI treatment and development of irAEs, which suggests that RT may boost the therapeutic effect of immunotherapy in patients with metastatic cancers.

see all

Series: Cancer immunology, immunotherapy
ISSN: 0340-7004
ISSN-E: 1432-0851
ISSN-L: 0340-7004
Volume: 72
Issue: 10
Pages: 3337 - 3347
DOI: 10.1007/s00262-023-03494-4
Type of Publication: A1 Journal article – refereed
Field of Science: 3126 Surgery, anesthesiology, intensive care, radiology
3122 Cancers
Funding: Open access funding provided by University of Eastern Finland (UEF) including Kuopio University Hospital. This work was supported by a Grant from the Northern Finland Cancer Society (Pohjois-Suomen syöpäyhdistys r.y.) (A.J.) and Terttu Foundation (A.J.). S.I.’s institution has received research funding from AstraZeneca and Roche. The funding bodies did not contribute to study design, data collection, data analysis or writing this article.
Copyright information: © The Author(s) 2023. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit