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Review Open Access

Immunotherapy combined with radiotherapy for advanced non‑small cell lung cancer: Current status and challenge (Review)

  • Authors:
    • Qiong Li
    • Ya-Qin Cai
    • Li-Hua Shao
    • Yue-Xiao Qi
    • Li-Yun Guo
    • Hai-Xia Song
    • Yu-Mei Dong
    • Shi-Hong Wei
  • View Affiliations / Copyright

    Affiliations: Department of Radiation Oncology, Gansu Provincial Cancer Hospital, Gansu Provincial Academy of Medical Science, Lanzhou, Gansu 730050, P.R. China
    Copyright: © Li et al. This is an open access article distributed under the terms of Creative Commons Attribution License.
  • Article Number: 469
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    Published online on: August 4, 2025
       https://doi.org/10.3892/ol.2025.15215
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Abstract

Immunotherapy, particularly immune checkpoint inhibitors (ICIs), has revolutionized the treatment landscape for advanced non‑small cell lung cancer (NSCLC) in previous years. However, not all patients achieve a satisfactory objective response and long‑term benefits, leading to growing interest in combining immunotherapy with radiotherapy (RT) to enhance therapeutic outcomes. The present review explored the rationale, efficacy and safety of combining RT with immunotherapy in advanced NSCLC. RT can potentiate immune responses through various mechanisms, such as immunogenic cell death and modification of the tumor microenvironment. The addition of RT to immunotherapy has notable synergistic antitumor effects to improve systemic control as RT can induce diverse immunomodulatory effects. The present review assessed the efficacy and safety of combining ICIs with RT and examined the optimal timing, dose and fraction strategies of RT for enhancing immune activation while minimizing toxicity. Additionally, the potential of RT to overcome primary and acquired resistance to immunotherapy was discussed. Despite encouraging findings, challenges such as optimal patient selection and biomarkers, treatment‑related toxicity and precise timing of interventions remain unresolved. The present review aimed to provide a comprehensive analysis of current evidence, as well as the key considerations for integrating RT and immunotherapy into clinical practice.
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The Selective Personalized Radio-Immunotherapy for Locally Advanced NSCLC Trial (SPRINT). https://clinicaltrials.gov/study/NCT03523702?cond=NCT03523702&rank=1

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Unresectable Stage IIIA/ IIIB Non-small Cell Lung Cancer (NSCLC). https://clinicaltrials.gov/study/NCT03285321?cond=NCT03285321&rank=1

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A Study to Determine Safety of Durvalumab After Sequential Chemo Radiation in Patients With Unresectable Stage III Non-Small Cell Lung Cancer. https://clinicaltrials.gov/study/NCT03693300?cond=NCT03693300&rank=1

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Study of Nivolumab for Non-Small Cell Lung Cancer (Stage III) Following Neoadjuvant Chemotherapy Plus Nivolumab and Definitive Concurrent Chemoradiation Therapy. https://clinicaltrials.gov/study/NCT04085250?cond=NCT04085250&rank=1

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A Study of Durvalumab as Consolidation Therapy in Non-Small Cell Lung Cancer Patients (PACIFIC-5). https://clinicaltrials.gov/study/NCT03706690?cond=NCT03706690&rank=1

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A Study of Nivolumab and Ipilimumab in Untreated Participants With Stage 3 Non-small Cell Lung Cancer (NSCLC) That is Unable or Not Planned to be Removed by Surgery (CheckMate73L). https://clinicaltrials.gov/study/NCT04026412?cond=NCT04026412&rank=1

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NIvolumab COmbination With Standard First-line Chemotherapy and Radiotherapy in Locally Advanced Stage IIIA/ B Non-Small Cell Lung Carcinoma (NICOLAS). https://clinicaltrials.gov/study/NCT02434081?cond=NCT02434081&rank=1

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Chemo-immunotherapy, Hypo-fractionated RT and Maintenance Immunotherapy for Stage III NSCLC. (DEDALUS). https://clinicaltrials.gov/study/NCT05128630?cond=NCT05128630&rank=1

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Use of High Dose Radiation Followed by Chemotherapy and Radiation to Treat Locally Advanced NSCLC. https://clinicaltrials.gov/study/NCT03141359?cond=NCT03141359&rank=1

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Pembrolizumab After SBRT Versus Pembrolizumab Alone in Advanced NSCLC (PEMBRO-RT). https://clinicaltrials.gov/study/NCT02492568?cond=NCT02492568&rank=1

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SBRT in Multi-metastatic NSCLC Patients Which Are Pan-negative for Driver Mutations. https://clinicaltrials.gov/study/NCT02940990?cond=NCT02940990&rank=1

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UCDCC#270, . Avelumab and Stereotactic Ablative Radiotherapy in Non-responding and Progressing NSCLC Patients. https://clinicaltrials.gov/study/NCT03158883?cond=NCT03158883&rank=1

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Immunotherapy With or Without SBRT in Patients With Stage IV Non-small Cell Lung Cancer. https://clinicaltrials.gov/study/NCT03867175?cond=NCT03867175&rank=1

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Pembrolizumab and Stereotactic Body Radiation Therapy or Non-Stereotactic Wide-Field Radiation Therapy in Treating Patients With Non-small Cell Lung Cancer. https://clinicaltrials.gov/study/NCT02444741?cond=NCT02444741&rank=1

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Radiation and Immune Checkpoints Blockade in Metastatic NSCLC (BMS # CA209-632). https://clinicaltrials.gov/study/NCT03168464?cond=NCT03168464&rank=1

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Atezolizumab and Varlilumab in Combination With Radiation Therapy for NSCLC. https://clinicaltrials.gov/study/NCT04081688?cond=NCT04081688&rank=1

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Radical-Dose Image Guided Radiation Therapy in Treating Patients With Metastatic Non-small Cell Lung Cancer Undergoing Immunotherapy. https://clinicaltrials.gov/study/NCT03176173?cond=NCT03176173&rank=1

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Nivolumab and Radiation Therapy With or Without Ipilimumab in Treating Patients With Brain Metastases From Non-small Cell Lung Cancer. https://clinicaltrials.gov/study/NCT02696993?cond=NCT02696993&rank=1

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Immunotherapy SBRT Sensitization of the Programmed Death-1 (PD-1) Effect (I-SABR). https://clinicaltrials.gov/study/NCT03825510?cond=NCT03825510&rank=1

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Safety and Tolerability Evaluation of Sintilimab in Combination With Radiation in Stage IV NSCLC Patients. https://clinicaltrials.gov/study/NCT03812549?cond=NCT03812549&rank=1

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Testing the Addition of Radiation Therapy to the Usual Treatment (Immunotherapy With or Without Chemotherapy) for Advanced Stage Non-small Cell Lung Cancer Patients Who Are PD-L1 Negative. https://clinicaltrials.gov/study/NCT04929041?cond=NCT04929041&rank=1

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Efficacy and Safety of Sintilimab With or Without Radiotherapy in Patients With Recurrent or IV NSCLC (EGFR-ALK-) After Failure of Platinum-based Chemotherapy. A Randomized, Open Labled, Phase II Clinical Study. https://clinicaltrials.gov/study/NCT04513301?cond=NCT04513301&rank=1

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Concurrent or Sequential Immunotherapy and Radiation Therapy in Patients With Metastatic Lung Cancer (COSINR). https://clinicaltrials.gov/study/NCT03223155?cond=NCT03223155&rank=1

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Camrelizumab Combined With Local Treatment in NSCLC Patients With BM. https://clinicaltrials.gov/study/NCT04291092?cond=NCT04291092&rank=1

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SinTilimab After Radiation (STAR Study) (STAR). https://clinicaltrials.gov/study/NCT04167657?cond=NCT04167657&rank=1

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NBTXR3 Activated by Radiotherapy for Patients with Advanced Cancers Treated with an Anti-PD-1 Therapy. https://clinicaltrials.gov/study/NCT03589339?cond=NCT03589339&rank=1

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Immunotherapy, Chemotherapy, Radiotherapy and Surgery for Synchronous Oligo-metastatic NSCLC (CHESS). https://clinicaltrials.gov/study/NCT03965468?cond=NCT03965468&rank=1

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Hypofractionated Radiation Therapy to Improve Immunotherapy Response in Non-Small Cell Lung Cancer. https://clinicaltrials.gov/study/NCT03035890?cond=NCT03035890&rank=1

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Atezolizumab Plus 8 Gy Single-fraction Radiotherapy for Advanced Oligoprogressive NSCLC. https://clinicaltrials.gov/study/NCT04549428?cond=NCT04549428&rank=1

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Phase Ib Study of Stereotactic Body Radiotherapy (SBRT) in Oligometastatic Non-small Lung Cancer (NSCLC) With Dual Immune Checkpoint Inhibition. https://clinicaltrials.gov/study/NCT03275597?cond=NCT03275597&rank=1

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Study of Stereotactic Ablative Radiotherapy(SBRT) Followed by Atezolizumab/Tiragolumab in Treatment-naive Patients With Metastatic Non-small Cell Lung Cancer (SKYROCKET). https://clinicaltrials.gov/study/NCT05034055?cond=NCT05034055&rank=1

169 

Durvalumab (MEDI4736) and Radiosurgery (fSRT vs. PULSAR) for the Treatment of Non-Small Cell Lung Cancer Brain Metastases. https://clinicaltrials.gov/study/NCT04889066?cond=NCT04889066&rank=1

170 

Durvalumab and Stereotactic Radiotherapy for Advanced NSCLC. https://clinicaltrials.gov/study/NCT04786093?cond=NCT04786093&rank=1

171 

Radiomic Signature as Predictive Marker of Response to Chemoradiation and Durvalumab in Stage III NSCLC. https://clinicaltrials.gov/study/NCT04364776?cond=NCT04364776&rank=1

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Clinical Trial Assessing the Efficacy of Abscopal Effect Induced by SBRT and Immunotherapy in Advanced NSCLC. https://clinicaltrials.gov/study/NCT04238169?cond=NCT04238169&rank=1

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Copy and paste a formatted citation
Spandidos Publications style
Li Q, Cai Y, Shao L, Qi Y, Guo L, Song H, Dong Y and Wei S: Immunotherapy combined with radiotherapy for advanced non‑small cell lung cancer: Current status and challenge (Review). Oncol Lett 30: 469, 2025.
APA
Li, Q., Cai, Y., Shao, L., Qi, Y., Guo, L., Song, H. ... Wei, S. (2025). Immunotherapy combined with radiotherapy for advanced non‑small cell lung cancer: Current status and challenge (Review). Oncology Letters, 30, 469. https://doi.org/10.3892/ol.2025.15215
MLA
Li, Q., Cai, Y., Shao, L., Qi, Y., Guo, L., Song, H., Dong, Y., Wei, S."Immunotherapy combined with radiotherapy for advanced non‑small cell lung cancer: Current status and challenge (Review)". Oncology Letters 30.4 (2025): 469.
Chicago
Li, Q., Cai, Y., Shao, L., Qi, Y., Guo, L., Song, H., Dong, Y., Wei, S."Immunotherapy combined with radiotherapy for advanced non‑small cell lung cancer: Current status and challenge (Review)". Oncology Letters 30, no. 4 (2025): 469. https://doi.org/10.3892/ol.2025.15215
Copy and paste a formatted citation
x
Spandidos Publications style
Li Q, Cai Y, Shao L, Qi Y, Guo L, Song H, Dong Y and Wei S: Immunotherapy combined with radiotherapy for advanced non‑small cell lung cancer: Current status and challenge (Review). Oncol Lett 30: 469, 2025.
APA
Li, Q., Cai, Y., Shao, L., Qi, Y., Guo, L., Song, H. ... Wei, S. (2025). Immunotherapy combined with radiotherapy for advanced non‑small cell lung cancer: Current status and challenge (Review). Oncology Letters, 30, 469. https://doi.org/10.3892/ol.2025.15215
MLA
Li, Q., Cai, Y., Shao, L., Qi, Y., Guo, L., Song, H., Dong, Y., Wei, S."Immunotherapy combined with radiotherapy for advanced non‑small cell lung cancer: Current status and challenge (Review)". Oncology Letters 30.4 (2025): 469.
Chicago
Li, Q., Cai, Y., Shao, L., Qi, Y., Guo, L., Song, H., Dong, Y., Wei, S."Immunotherapy combined with radiotherapy for advanced non‑small cell lung cancer: Current status and challenge (Review)". Oncology Letters 30, no. 4 (2025): 469. https://doi.org/10.3892/ol.2025.15215
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