Immunotherapy in Combination with Radiotherapy

Ozge Sagıroglu has worked in MedTech and the diagnostics field for more than 20 years in Europe and Emerging markets. For the last five years she is in Elekta, a Swedish company and a leader in precision radiation therapy. Through decades of experience as a commercial and marketing leader, Ozge has a deep understanding of medical technology and knowledge of emerging markets.

In a conversation with Prisila, a correspondent in Asia Business outlook Magazine. Ozge shared her view about the breakthroughs in radio- therapy technology and how do emerging imaging technologies, such as MRI-guided radiotherapy, enhance precision in treatment planning and delivery.

What are the most recent breakthroughs in radiotherapy technology, and how do they contribute to enhancing patient outcomes?

Some of the key breakthroughs in radiotherapy in recent years include:

• Increasing adoption of hypofractionation

Hypofractionation is a type of radiotherapy that involves delivering technology evolution and clinical evidence generation. This can shorten the overall treatment time, reduce the inconvenience and cost for the patients, and improve the quality of life.

• Biology-guided radiation therapy (BGRT)

BGRT takes us into a molecular era in RT as an evolution of personalized and adaptive RT. Rapid advances in functional and biological imaging, predictive assays, and understanding of the molecular and cellular responses underpinning treatment outcomes herald the implementation of patient-specific BGRT in the clinic.

• Increasing use of artificial intelligence (AI) in radiotherapy

Integrating data and artificial intelligence (AI) in radiotherapy can create powerful tools that can enhance the quality and efficiency of radiotherapy by automating and optimizing various aspects of the treatment process, such as contouring, planning, delivery, and outcome prediction.

• Magnetic resonance imaging-guided radiotherapy (MRgRT)

MRgRT integrates radiotherapy with magnetic resonance imaging (MRI) to provide high-quality images of the tumor and surrounding tissues during treatment. MRgRT enables better visualization and monitoring of the tumor response and normal tissue changes, and allows for adaptive RT and more accurate and personalized dose delivery. For suitable patients, this could mean less treatment sessions with fewer side effects, or increased eligibility for more ablative treatments which could change outcomes.

How do emerging imaging technologies, such as MRI-guided radiotherapy, enhance precision in treatment planning and delivery?

Magnetic Resonance-guided Radiation Therapy (MRgRT) contributes to enhancing patient outcomes in several ways:

• Real-Time Imaging: One of the primary advantages of MRgRT is the ability to acquire high-quality, real-time images of the tumor and surrounding anatomy during the radiation treatment. This provides clinicians with the opportunity to adapt the treatment plan based on the current position and shape of the tumor, as well as changes in nearby organs.
• Precise Targeting: The real-time imaging capability enhances the precision of radiation therapy delivery. With the ability to visualize the tumor and surrounding structures in detail, clinicians can make immediate adjustments to ensure that the radiation is precisely targeted to the tumor, minimizing exposure to healthy tissues.
• Soft Tissue Visualization: MRI is particularly effective in visualizing soft tissues, which can be challenging with other imaging modalities like CT scans. This is especially valuable in cases where tumors are located near critical structures or involve soft tissue structures.
• Adaptive Radiation Therapy (ART): ART involves adjusting the treatment plan during the course of therapy based on changes in the tumor or surrounding anatomy. This adaptive approach helps to account for variations in patient anatomy and tumor response, improving treatment accuracy.

MRgRT offers more effective and personalized radiation therapy, leading to better outcomes for patients.

How does the use of 3D printing and patient-specific devices contribute to the advancement of radiotherapy techniques?

The use of 3D printing and patient-specific devices contributes to the advancement of radiotherapy techniques by improving the accuracy, precision, conformity, and comfort of radiation delivery to the tumor, while minimizing the exposure and damage to the surrounding healthy tissues and organs.

Can you provide insights into the role of immunotherapy in combination with radiotherapy for cancer treatment, and how it's impacting clinical outcomes?

The combination of immunotherapy and radiotherapy has emerged as a promising approach in cancer treatment, leveraging the strengths of both modalities to enhance therapeutic outcomes. Immunotherapy aims to harness the body's immune system to recognize and attack cancer cells, while radiotherapy uses targeted radiation to damage and destroy cancer cells. When used together, these modalities can have synergistic effects, leading to improved clinical outcomes.

Some clinics, for example, have combined immunotherapy (immune checkpoint inhibitors) with Gamma Knife® radiosurgery to treat patients with brain metastases. This combination therapy has for example, been demonstrated to improve tumor control and survival in patients with melanoma brain metastases.

How do you see the future of radiotherapy evolving in the next 5-10 years with the continued advancement of technology and research?

The future of radiotherapy holds exciting possibilities as technology and research continue to advance. Some of the possible trends and developments that could emerge in the next 5-10 years include:

Precision and Personalization

Adaptive radiotherapy: Real-time imaging and adaptive planning techniques will enable increasing numbers of adjusted treatment plans based on changes in tumor size, shape, and position during the course of treatment.

Technological Innovations

Continued development of advanced imaging and treatment delivery capabilities will expand numbers of hypofractionated courses and the potential of sophisticated techniques such as MRI guided stereotactic radiotherapy to expand the role of radiotherapy in cancer care and it’s positive effect on patient outcomes.

Integration with Immunotherapy

The integration of radiotherapy with immunotherapy is expected to become more refined and personalized, with ongoing research aiming to optimize treatment combinations, sequences, and patient selection.

"Immunotherapy aims to harness the body's immune system to recognize and attack cancer cells, while radiotherapy uses targeted radiation to damage and destroy cancer cells"

Artificial Intelligence (AI) and Data

AI could have particularly transformative applications in radiation oncology given the multifaceted and highly technical nature of this field of medicine with a heavy reliance on digital data processing and computer software. AI will not just improve efficiency, it has the potential to improve the accuracy, precision, and overall quality of radiation therapy for patients with cancer. AI and machine learning algorithms will play a role in analyzing patient data and predict treatment outcomes, assisting clinicians in making more informed decisions about the most effective treatment strategies.

Access to radiation therapy in emerging markets

There is a huge gap between the clinical need and the availability of radiation therapy in emerging markets, where 85 percent of the global population lives, but only 40 percent of the radiation therapy devices are installed. To overcome these barriers, radiotherapy will benefit from the implementation of innovative solutions, such as cloud-based platforms, telemedicine, and innovative education and training that could improve the access, affordability, and quality of radiotherapy for underserved populations.

These developments hold the potential to further improve treatment outcomes, minimize side effects, and enhance the overall effectiveness of radiotherapy in cancer care.