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Anti-PD-(L)1 mAb

Study design
RT–Drug Timing Window
Data: details & interpretation
Excerpts from the LINACS publication (Sundahl et al., Radiother Oncol 2026):

“Anti-PD(L)1 combined with SRT within the same month also appears not to increase AEs overall. An exception was liver-directed SRT, with a high rate (30%) of high-grade OAEs, though it may reflect an additive effect, as liver SRT alone can cause up to 10% hgAEs.[1-3] In-field AE data were generally unavailable, limiting interpretation. Notably, in a separate study, RTAEs were only observed in 1/15 patients (6.7%) and the ESMO-ESTRO consensus paper suggests the observed risk of AEs to be low, although this discussion did not specifically pertain to liver-directed SRT.[4] Nevertheless, additional caution may be warranted when delivering liver SRT to patients receiving anti-PD(L)1. Notably, anti-PD(L)1 mAb have long half-lives and immunologic effects that may persist after discontinuation. Therefore, it is uncertain whether a brief treatment interruption or delay meaningfully reduces the risk of inflammatory toxicity. Alternatively, radiotherapy dose reduction or a technique that improves normal-tissue sparing may be considered.[4]”

“For anti-programmed cell death (ligand) 1 (anti-PD(L)1) mAb, sixty-nine studies[5-73] (43 prospective and 26 retrospective) included 2166 patients treated with anti-PD(L)1 within one month of SRT (wmFUP: 19.1mo). HgRTAEs were observed in 6.4% (37/582), while hgOAEs occurred in 14.2% (225/1584). No increased AE rate was noted for brain, lung, pancreas or bone SRT (Fig 4a; Supplementary).

Eight studies[12-15,19,28,62,67] (six prospective and two retrospective) included 190 patients treated with liver SRT within one month of anti-PD(L)1 (wmFUP: 26mo). HgOAEs occurred in 30.3% (53/175) of patients. Notably, many AEs were laboratory abnormalities, and 87 patients (49.7%) also underwent transarterial embolization (TAE). Excluding TAE studies, the hgOAE rate remained 27.7% among 74 patients. RTAE data were available for only 15 patients, of whom one (6.7%) experienced a hgRTAE.”

“Seventeen studies (four prospective and 13 retrospective) included 537 patients treated with intracranial SRT within one month of anti-PD(L)1[8,24,25,31,35,36,38,40,43,44,49,52,56,64,71-73] (wmFUP: 17.2mo). SRT doses ranged from 25Gy/5# to 25Gy/1#. The rate of hgOAE was 10.5% (31/295), while the rate of hgRTAEs was 6.2% (15/242).

Eleven studies (ten prospective and one retrospective) included 297 patients treated with lung SRT within one month of anti-PD(L)1[8,10,16,17,20,51,53,57,58,68,74] (wmFUP: 22.3mo). SRT schedules varied, and ranged from 18Gy/3# to 54Gy/3#. HgOAEs occurred in 17.2% (34/198); while hgRTAEs were reported in 5.8% (4/69).

One prospective study[23] included 31 patients treated with SRT to the bone (20Gy/1#) within one month of anti-PD(L)1 (wmFUP: 18mo). A hgOAE rate of 16.1% was observed.

Two prospective studies[50,66] included 69 patients treated with SRT to the primary pancreatic tumor (dose of either 32Gy/4# or 33Gy/5#) in combination with anti-PD(L)1 within one month (wmFUP: 19.6mo). In one study, 54 patients additionally received a granulocyte-macrophage colony-stimulating factor (GM-CSF)-secreting allogeneic pancreatic cancer vaccine. HgOAEs were observed in 13% (9/69 patients).”

References (74)
  1. 1. Kiess AP, Wolchok JD, Barker CA, et al. Stereotactic radiosurgery for melanoma brain metastases in patients receiving ipilimumab: safety profile and efficacy of combined treatment. Int J Radiat Oncol Biol Phys. Jun 1 2015;92(2):368–75. doi:10.1016/j.ijrobp.2015.01.004
  2. 2. Skrepnik T, Sundararajan S, Cui H, Stea B. Improved time to disease progression in the brain in patients with melanoma brain metastases treated with concurrent delivery of radiosurgery and ipilimumab. Oncoimmunology. 2017;6(3):e1283461. doi:10.1080/2162402x.2017.1283461
  3. 3. Sundahl N, De Wolf K, Kruse V, et al. Phase 1 Dose Escalation Trial of Ipilimumab and Stereotactic Body Radiation Therapy in Metastatic Melanoma. Int J Radiat Oncol Biol Phys. Mar 15 2018;100(4):906–915. doi:10.1016/j.ijrobp.2017.11.029
  4. 4. van Aken ESM, Devnani B, Prelaj A, et al. ESMO-ESTRO consensus statements on the safety of combining radiotherapy with immune checkpoint inhibitors, VEGF(R) inhibitors, or multitargeted tyrosine kinase inhibitors. Ann Oncol. Jan 2026;37(1):17–32. doi:10.1016/j.annonc.2025.09.008
  5. 5. Dengina N, Mitin T, Gamayunov S, Safina S, Kreinina Y, Tsimafeyeu I. Stereotactic body radiation therapy in combination with systemic therapy for metastatic renal cell carcinoma: a prospective multicentre study. ESMO Open. 2019;4(5):e000535. doi:10.1136/esmoopen-2019-000535
  6. 6. Franzese C, Marvaso G, Francolini G, et al. The role of stereotactic body radiation therapy and its integration with systemic therapies in metastatic kidney cancer: a multicenter study on behalf of the AIRO (Italian Association of Radiotherapy and Clinical Oncology) genitourinary study group. Clin Exp Metastasis. Dec 2021;38(6):527–537. doi:10.1007/s10585-021-10131-w
  7. 7. Franzese C, Marini B, Baldaccini D, et al. The impact of stereotactic ablative radiotherapy on oligoprogressive metastases from renal cell carcinoma. J Cancer Res Clin Oncol. Jul 2023;149(8):4411–4417. doi:10.1007/s00432-022-04352-z
  8. 8. Looman EL, Kroeze SGC, Schaule J, et al. Adverse Events After Metastases-Directed Stereotactic Radiotherapy and Biological Cancer Therapy. JAMA Netw Open. 2026/01/02/ 2026;9(1):e2553809. doi:10.1001/jamanetworkopen.2025.53809
  9. 9. Kroeze SGC, Schaule J, Fritz C, et al. Metastasis directed stereotactic radiotherapy in NSCLC patients progressing under targeted- or immunotherapy: efficacy and safety reporting from the 'TOaSTT' database. Radiat Oncol. Jan 6 2021;16(1):4. doi:10.1186/s13014-020-01730-0
  10. 10. Chang JY, Lin SH, Dong W, et al. Stereotactic ablative radiotherapy with or without immunotherapy for early-stage or isolated lung parenchymal recurrent node-negative non-small-cell lung cancer: an open-label, randomised, phase 2 trial. Lancet (London, England). Sep 9 2023;402(10405):871–881. doi:10.1016/s0140-6736(23)01384-3
  11. 11. Chen IM, Johansen JS, Theile S, et al. Randomized Phase II Study of Nivolumab With or Without Ipilimumab Combined With Stereotactic Body Radiotherapy for Refractory Metastatic Pancreatic Cancer (CheckPAC). Journal of clinical oncology : official journal of the American Society of Clinical Oncology. Sep 20 2022;40(27):3180–3189. doi:10.1200/jco.21.02511
  12. 12. Chiang CL, Chan ACY, Chiu KWH, Kong FS. Combined Stereotactic Body Radiotherapy and Checkpoint Inhibition in Unresectable Hepatocellular Carcinoma: A Potential Synergistic Treatment Strategy. Front Oncol. 2019;9:1157. doi:10.3389/fonc.2019.01157
  13. 13. Chiang CL, Chiu KWH, Chan KSK, et al. Sequential transarterial chemoembolisation and stereotactic body radiotherapy followed by immunotherapy as conversion therapy for patients with locally advanced, unresectable hepatocellular carcinoma (START-FIT): a single-arm, phase 2 trial. The lancet Gastroenterology & hepatology. Feb 2023;8(2):169–178. doi:10.1016/s2468-1253(22)00339-9
  14. 14. Chiang CL, Chan KSK, Chiu KWH, et al. Complete Response to Locoregional Therapy Plus Immunotherapy for Hepatocellular Carcinoma. JAMA Oncol. 2024/11/01/ 2024;10(11):1548–1553. doi:10.1001/jamaoncol.2024.4085
  15. 15. Chiang CL, Lee FAS, Chan KSK, et al. Survival Outcome Analysis of Stereotactic Body Radiotherapy and Immunotherapy (SBRT-IO) versus SBRT-Alone in Unresectable Hepatocellular Carcinoma. Liver Cancer. Jun 2024;13(3):265–276. doi:10.1159/000533425
  16. 16. Feng X, Liu X, Guan H, et al. Safety and Efficacy of Radiotherapy Combined With Sintilimab in Advanced NSCLC Patients Who Progressed on First or Second Line Therapy: A Prospective, Multiple Center, and Single-Arm Study. Thoracic cancer. 2025/03//undefined 2025;16(6):e70043. doi:10.1111/1759-7714.70043
  17. 17. Horndalsveen H, Alver TN, Dalsgaard AM, et al. Atezolizumab and stereotactic body radiotherapy in patients with advanced non-small cell lung cancer: safety, clinical activity and ctDNA responses-the ComIT-1 trial. Mol Oncol. Mar 2023;17(3):487–498. doi:10.1002/1878-0261.13330
  18. 18. Hubbeling HG, Schapira EF, Horick NK, et al. Safety of Combined PD-1 Pathway Inhibition and Intracranial Radiation Therapy in Non-Small Cell Lung Cancer. Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer. Apr 2018;13(4):550–558. doi:10.1016/j.jtho.2018.01.012
  19. 19. Juloori A, Katipally RR, Lemons JM, et al. Phase 1 Randomized Trial of Stereotactic Body Radiation Therapy Followed by Nivolumab plus Ipilimumab or Nivolumab Alone in Advanced/Unresectable Hepatocellular Carcinoma. Int J Radiat Oncol Biol Phys. Jan 1 2023;115(1):202–213. doi:10.1016/j.ijrobp.2022.09.052
  20. 20. Kievit H, Muntinghe-Wagenaar MB, Hijmering-Kappelle LBM, et al. Safety and tolerability of stereotactic radiotherapy combined with durvalumab with or without tremelimumab in advanced non-small cell lung cancer, the phase I SICI trial. Lung cancer (Amsterdam, Netherlands). Apr 2023;178:96–102. doi:10.1016/j.lungcan.2023.02.004
  21. 21. Korpics MC, Onderdonk BE, Dadey RE, et al. Partial tumor irradiation plus pembrolizumab in treating large advanced solid tumor metastases. The Journal of clinical investigation. May 15 2023;133(10) doi:10.1172/jci162260
  22. 22. Kroeze SGC, Fritz C, Schaule J, et al. Stereotactic radiotherapy combined with immunotherapy or targeted therapy for metastatic renal cell carcinoma. BJU Int. Jun 2021;127(6):703–711. doi:10.1111/bju.15284
  23. 23. Kwan EM, Spain L, Anton A, et al. Avelumab Combined with Stereotactic Ablative Body Radiotherapy in Metastatic Castration-resistant Prostate Cancer: The Phase 2 ICE-PAC Clinical Trial. Eur Urol. Mar 2022;81(3):253–262. doi:10.1016/j.eururo.2021.08.011
  24. 24. Lee MH, Cho KR, Choi JW, et al. Immune Checkpoint Inhibitors for Non-Small-Cell Lung Cancer with Brain Metastasis : The Role of Gamma Knife Radiosurgery. Journal of Korean Neurosurgical Society. Mar 2021;64(2):271–281. doi:10.3340/jkns.2020.0135
  25. 25. Levy A, Massard C, Soria JC, Deutsch E. Concurrent irradiation with the anti-programmed cell death ligand-1 immune checkpoint blocker durvalumab: Single centre subset analysis from a phase 1/2 trial. European journal of cancer (Oxford, England : 1990). Nov 2016;68:156–162. doi:10.1016/j.ejca.2016.09.013
  26. 26. Levy A, Morel D, Texier M, et al. An international phase II trial and immune profiling of SBRT and atezolizumab in advanced pretreated colorectal cancer. Mol Cancer. Mar 23 2024;23(1):61. doi:10.1186/s12943-024-01970-8
  27. 27. Levy A, Morel D, Texier M, et al. Monocyte-lineage tumor infiltration predicts immunoradiotherapy response in advanced pretreated soft-tissue sarcoma: phase 2 trial results. Signal Transduct Target Ther. 2025/03/17/ 2025;10(1):103. doi:10.1038/s41392-025-02173-3
  28. 28. Li Z, Liu J, Zhang B, et al. Neoadjuvant tislelizumab plus stereotactic body radiotherapy and adjuvant tislelizumab in early-stage resectable hepatocellular carcinoma: the Notable-HCC phase 1b trial. Nat Commun. Apr 16 2024;15(1):3260. doi:10.1038/s41467-024-47420-3
  29. 29. Lin J, Guo Q, Guo Z, et al. Stereotactic body radiotherapy extends the clinical benefit of PD-1 inhibitors in refractory recurrent/metastatic nasopharyngeal carcinoma. Radiat Oncol. Jul 5 2022;17(1):117. doi:10.1186/s13014-022-02073-8
  30. 30. Luke JJ, Lemons JM, Karrison TG, et al. Safety and Clinical Activity of Pembrolizumab and Multisite Stereotactic Body Radiotherapy in Patients With Advanced Solid Tumors. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. Jun 1 2018;36(16):1611–1618. doi:10.1200/jco.2017.76.2229
  31. 31. Mahase SS, Roytman M, Roth O'Brien D, et al. Concurrent immunotherapy and re-irradiation utilizing stereotactic body radiotherapy for recurrent high-grade gliomas. Cancer Rep (Hoboken). Jul 2023;6(7):e1788. doi:10.1002/cnr2.1788
  32. 32. Markussen A, Johansen JS, Larsen FO, et al. Nivolumab With or Without Ipilimumab Combined with Stereotactic Body Radiotherapy in patients with Metastatic Biliary Tract Cancer: A Randomized Phase 2 Study. Clinical cancer research : an official journal of the American Association for Cancer Research. Jun 14 2024; doi:10.1158/1078-0432.Ccr-24-0286
  33. 33. Masini C, Iotti C, De Giorgi U, et al. Nivolumab in Combination with Stereotactic Body Radiotherapy in Pretreated Patients with Metastatic Renal Cell Carcinoma. Results of the Phase II NIVES Study. Eur Urol. Mar 2022;81(3):274–282. doi:10.1016/j.eururo.2021.09.016
  34. 34. Mattes MD, Eubank TD, Almubarak M, et al. A Prospective Trial Evaluating the Safety and Systemic Response From the Concurrent Use of Radiation Therapy with Checkpoint Inhibitor Immunotherapy in Metastatic Non-Small Cell Lung Cancer. Clin Lung Cancer. Jul 2021;22(4):268–273. doi:10.1016/j.cllc.2021.01.012
  35. 35. Minniti G, Anzellini D, Reverberi C, et al. Stereotactic radiosurgery combined with nivolumab or Ipilimumab for patients with melanoma brain metastases: evaluation of brain control and toxicity. J Immunother Cancer. Apr 11 2019;7(1):102. doi:10.1186/s40425-019-0588-y
  36. 36. Minniti G, Lanzetta G, Capone L, et al. Leptomeningeal disease and brain control after postoperative stereotactic radiosurgery with or without immunotherapy for resected brain metastases. J Immunother Cancer. Dec 2021;9(12) doi:10.1136/jitc-2021-003730
  37. 37. Miyamoto S, Nomura R, Sato K, et al. Nivolumab and stereotactic radiation therapy for the treatment of patients with Stage IV non-small-cell lung cancer. Jpn J Clin Oncol. Feb 1 2019;49(2):160–164. doi:10.1093/jjco/hyy171
  38. 38. Nardin C, Mateus C, Texier M, et al. Tolerance and outcomes of stereotactic radiosurgery combined with anti-programmed cell death-1 (pembrolizumab) for melanoma brain metastases. Melanoma Res. Apr 2018;28(2):111–119. doi:10.1097/cmr.0000000000000413
  39. 39. Ni J, Zhou Y, Wu L, et al. Sintilimab, stereotactic body radiotherapy and granulocyte-macrophage colony stimulating factor as second-line therapy for advanced non-small cell lung cancer: safety run-in results of a multicenter, single-arm, phase II trial. Radiat Oncol. Sep 15 2021;16(1):177. doi:10.1186/s13014-021-01905-3
  40. 40. Pouessel D, Ken S, Gouaze-Andersson V, et al. Hypofractionated Stereotactic Re-irradiation and Anti-PDL1 Durvalumab Combination in Recurrent Glioblastoma: STERIMGLI Phase I Results. The oncologist. Sep 7 2023;28(9):825–e817. doi:10.1093/oncolo/oyad095
  41. 41. Rimner A, Adusumilli PS, Offin MD, et al. A Phase 1 Safety Study of Avelumab Plus Stereotactic Body Radiation Therapy in Malignant Pleural Mesothelioma. JTO Clin Res Rep. Jan 2023;4(1):100440. doi:10.1016/j.jtocrr.2022.100440
  42. 42. Sari SY, Yilmaz MT, Aktas BY, et al. Results of concurrent radiotherapy and immunotherapy in recurrent and metastatic head and neck cancer: A single-center experience. Oral Oncol. Jan 2022;124:105658. doi:10.1016/j.oraloncology.2021.105658
  43. 43. Schapira E, Hubbeling H, Yeap BY, et al. Improved Overall Survival and Locoregional Disease Control With Concurrent PD-1 Pathway Inhibitors and Stereotactic Radiosurgery for Lung Cancer Patients With Brain Metastases. Int J Radiat Oncol Biol Phys. Jul 1 2018;101(3):624–629. doi:10.1016/j.ijrobp.2018.02.175
  44. 44. Scoccianti S, Olmetto E, Pinzi V, et al. Immunotherapy in association with stereotactic radiotherapy for non-small cell lung cancer brain metastases: results from a multicentric retrospective study on behalf of AIRO. Neuro Oncol. Oct 1 2021;23(10):1750–1764. doi:10.1093/neuonc/noab129
  45. 45. Siva S, Bressel M, Wood ST, et al. Stereotactic Radiotherapy and Short-course Pembrolizumab for Oligometastatic Renal Cell Carcinoma-The RAPPORT Trial. Eur Urol. Apr 2022;81(4):364–372. doi:10.1016/j.eururo.2021.12.006
  46. 46. Spaas M, Sundahl N, Kruse V, et al. Checkpoint Inhibitors in Combination With Stereotactic Body Radiotherapy in Patients With Advanced Solid Tumors: The CHEERS Phase 2 Randomized Clinical Trial. JAMA Oncol. Sep 1 2023;9(9):1205–1213. doi:10.1001/jamaoncol.2023.2132
  47. 47. Sundahl N, Seremet T, Van Dorpe J, et al. Phase 2 Trial of Nivolumab Combined With Stereotactic Body Radiation Therapy in Patients With Metastatic or Locally Advanced Inoperable Melanoma. Int J Radiat Oncol Biol Phys. Jul 15 2019;104(4):828–835. doi:10.1016/j.ijrobp.2019.03.041
  48. 48. Sundahl N, Vandekerkhove G, Decaestecker K, et al. Randomized Phase 1 Trial of Pembrolizumab with Sequential Versus Concomitant Stereotactic Body Radiotherapy in Metastatic Urothelial Carcinoma. Eur Urol. May 2019;75(5):707–711. doi:10.1016/j.eururo.2019.01.009
  49. 49. Trommer-Nestler M, Marnitz S, Kocher M, et al. Robotic Stereotactic Radiosurgery in Melanoma Patients with Brain Metastases under Simultaneous Anti-PD-1 Treatment. Int J Mol Sci. Sep 7 2018;19(9) doi:10.3390/ijms19092653
  50. 50. Vošmik M, John S, Dvořák J, et al. Stereotactic Radiotherapy Plus Nivolumab in Patients with Locally Advanced Pancreatic Cancer: Results from Phase 1/2 Clinical CA209-9KH Trial. Oncol Ther. 2024/12//undefined 2024;12(4):817–831. doi:10.1007/s40487-024-00309-z
  51. 51. Wang Z, Qiang Y, Shen Q, Zhu XX, Song Y. Neoadjuvant Programmed Cell Death Protein 1 Blockade Combined With Stereotactic Body Radiation Therapy for Stage III(N2) Non-Small Cell Lung Cancer: A Case Series. Front Oncol. 2022;12:779251. doi:10.3389/fonc.2022.779251
  52. 52. Wu S, Yuan C, Chen L, et al. Survival Benefits of Anti-PD-1 Therapy in Combination With Radiotherapy in Chinese Melanoma Patients With Brain Metastasis. Front Oncol. 2021;11:646328. doi:10.3389/fonc.2021.646328
  53. 53. Wu TC, Stube A, Felix C, et al. Safety and Efficacy Results From iSABR, a Phase 1 Study of Stereotactic ABlative Radiotherapy in Combination With Durvalumab for Early-Stage Medically Inoperable Non-Small Cell Lung Cancer. Int J Radiat Oncol Biol Phys. Sep 1 2023;117(1):118–122. doi:10.1016/j.ijrobp.2023.03.069
  54. 54. Xie C, Duffy AG, Brar G, et al. Correction: Immune Checkpoint Blockade in Combination with Stereotactic Body Radiotherapy in Patients with Metastatic Pancreatic Ductal Adenocarcinoma. Clinical cancer research : an official journal of the American Association for Cancer Research. Jan 1 2021;27(1):358. doi:10.1158/1078-0432.Ccr-20-4640
  55. 55. Ye H, Pang H, Shi X, et al. Nivolumab and Hypofractionated Radiotherapy in Patients With Advanced Lung Cancer: ABSCOPAL-1 Clinical Trial. Front Oncol. 2021;11:657024. doi:10.3389/fonc.2021.657024
  56. 56. Yuce Sari S, Aktas BY, Kertmen N, et al. Does Combined Fractionated Stereotactic Radiotherapy and Immunotherapy Change the Outcome of Recurrent High-Grade Gliomas? Cureus. Jun 2021;13(6):e15852. doi:10.7759/cureus.15852
  57. 57. Zhang X, Yan J, Lei Q, et al. A Randomized, Multicenter, Phase 2 Trial of Camrelizumab With or Without Metastasis-directed Stereotactic Body Radiation Therapy in Recurrent or Metastatic Nasopharyngeal Carcinoma. Int J Radiat Oncol Biol Phys. 2025/03/15/ 2025;121(4):980–990. doi:10.1016/j.ijrobp.2024.10.019
  58. 58. Zhou X, Zhou L, Yao Z, et al. Safety and Tolerability of Low-Dose Radiation and Stereotactic Body Radiotherapy + Sintilimab for Treatment-Naïve Stage IV PD-L1+ Non-Small Cell Lung Cancer Patients. Clinical cancer research : an official journal of the American Association for Cancer Research. Oct 13 2023;29(20):4098–4108. doi:10.1158/1078-0432.Ccr-23-0315
  59. 59. Zhu KK, Wei JL, Xu YH, et al. Effect of Stereotactic Body Radiation Therapy on Diverse Organ Lesions in Advanced Non-Small Cell Lung Cancer Patients Receiving Immune Checkpoint Inhibitors. Curr Med Sci. Apr 2023;43(2):344–359. doi:10.1007/s11596-023-2702-0
  60. 60. Chen H, Yu L, Liang F, et al. Consolidative stereotactic radiotherapy for oligo-residual non-small cell lung cancer after first-line chemoimmunotherapy: A single-arm, phase 2 trial from China. PLoS Med. 2025/08//undefined 2025;22(8):e1004680. doi:10.1371/journal.pmed.1004680
  61. 61. Chen Y-X, Yang P, Du S-S, et al. Stereotactic body radiotherapy combined with sintilimab in patients with recurrent or oligometastatic hepatocellular carcinoma: A phase II clinical trial. World J Gastroenterol. 2023/06/28/ 2023;29(24):3871–3882. doi:10.3748/wjg.v29.i24.3871
  62. 62. Deming DA, Kraus SG, Brand J, et al. Tumor matrix proteoglycan accumulation and processing alters T cell effector function and the response to immunotherapy in patients with oligometastatic colorectal cancer. Clinical cancer research : an official journal of the American Association for Cancer Research. 2026/02/11/ 2026; doi:10.1158/1078-0432.CCR-25-2780
  63. 63. Gandini A, Martelli V, Belgioia L, et al. Feasibility of stereotactic radiotherapy with pembrolizumab in patients with deficient mismatch repair/microsatellite unstable metastatic colorectal cancer. ESMO Gastrointest Oncol. 2024/09//undefined 2024;5:100069. doi:10.1016/j.esmogo.2024.100069
  64. 64. Giordano A, Graham N, Aizer AA, et al. A phase II study of atezolizumab in combination with stereotactic radiation for patients with triple-negative breast cancer and brain metastasis. Breast Cancer Res Treat. 2026/03/07/ 2026;216(2) doi:10.1007/s10549-026-07932-6
  65. 65. Kassardjian AA, Ladbury CJ, Tam A, et al. Outcomes and toxicity of concomitant radioimmunotherapy following PD-1 blockade for locally advanced and metastatic cutaneous squamous cell carcinoma. Front Oncol. 2025 2025;15:1679699. doi:10.3389/fonc.2025.1679699
  66. 66. Lee V, Sachidanand AS, Rodriguez C, et al. The combination of a cancer vaccine, pembrolizumab, and stereotactic body radiation in patients with locally advanced pancreatic cancer: a single-arm, phase II study. Nat Commun. 2026/03/18/ 2026; doi:10.1038/s41467-026-69294-3
  67. 67. O'Kane GM, Mesci A, Jang RW, et al. Pembrolizumab and stereotactic body radiotherapy combined in advanced hepatocellular carcinoma post sorafenib - A phase II trial (PEMRAD). JHEP Rep. 2026/02//undefined 2026;8(2):101658. doi:10.1016/j.jhepr.2025.101658
  68. 68. Schvartsman G, Amirato YM, Monfardini F, et al. Pathologic Responses to Stereotactic Ablative Radiotherapy in Combination With Nivolumab for Early Stage NSCLC: A Phase 2 Study. JTO Clin Res Rep. 2026/02//undefined 2026;7(2):100940. doi:10.1016/j.jtocrr.2025.100940
  69. 69. So J, Droznin AD, Tiwari P, et al. Stereotactic Body Radiation Therapy With Pembrolizumab in Programmed Cell Death Protein 1 Inhibitor-Refractory Recurrent or Metastatic Head and Neck Squamous Cell Carcinoma: A Phase 2 Trial. Int J Radiat Oncol Biol Phys. 2026/01/09/ 2026:S0360–3016(26)00004–0. doi:10.1016/j.ijrobp.2025.12.043
  70. 70. Zhu C, Xu Y, Wen J, et al. Stereotactic Body Radiation Therapy Augmented Checkpoint Inhibitor Immunotherapy Response in Heavily Pretreated Metastatic Osteosarcoma. Int J Radiat Oncol Biol Phys. 2025/11/29/ 2025:S0360–3016(25)06521–6. doi:10.1016/j.ijrobp.2025.11.042
  71. 71. Abdulhaleem M, Johnston H, D'Agostino R, Jr., et al. Local control outcomes for combination of stereotactic radiosurgery and immunotherapy for non-small cell lung cancer brain metastases. J Neurooncol. Mar 2022;157(1):101–107. doi:10.1007/s11060-022-03951-7
  72. 72. Ahmed KA, Kim Y, Arrington JA, et al. Nivolumab and Stereotactic Radiosurgery for Patients With Breast Cancer Brain Metastases: A Nonrandomized, Open-Label Phase 1b Study. Adv Radiat Oncol. Nov–Dec 2021;6(6):100798. doi:10.1016/j.adro.2021.100798
  73. 73. Ahmed KA, Kim S, Arrington J, et al. Outcomes targeting the PD-1/PD-L1 axis in conjunction with stereotactic radiation for patients with non-small cell lung cancer brain metastases. J Neurooncol. Jun 2017;133(2):331–338. doi:10.1007/s11060-017-2437-5
  74. 74. Altorki NK, McGraw TE, Borczuk AC, et al. Neoadjuvant durvalumab with or without stereotactic body radiotherapy in patients with early-stage non-small-cell lung cancer: a single-centre, randomised phase 2 trial. The Lancet Oncology. Jun 2021;22(6):824–835. doi:10.1016/s1470-2045(21)00149-2
Radiobiological rationale for RT–drug interaction
Immunologically synergistic ("in situ vaccine"), not a DNA-level sensitizer (Sharabi et al., Lancet Oncology, 2015; Lu and Deng, Journal of Clinical Investigation, 2026). The principal theoretical added risk is immune/inflammatory rather than classic in-field injury—overlap of radiation-induced inflammation with checkpoint-mediated immune activation provides a rationale for potentiated pneumonitis (with thoracic RT) and other immune-related organ adverse events(colitis, hepatitis).
The data above refer to patients treated with Anti-PD-(L)1 mAb as the sole drug class, excluding any concurrent use of drugs from other groups. Combination therapy data are available in the section below.
Individual Drugs

Select a drug to view its individual evidence base (drug + SBRT, no other concurrent systemic drugs). Drugs without available data are shown greyed out.

Atezolizumab Avelumab Camrelizumab Durvalumab Nivolumab Pembrolizumab Sintilimab Tislelizumab Toripalimab Cemiplimab
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 Cosibelimab
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 Dostarlimab
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 Penpulimab
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 Retifanlimab
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 Serplulimab
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 Sugemalimab
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