It is now clear that conventional radiation therapy can reinstate cell death immunogenicity. Recent preclinical data indicate that targeted radionuclide therapy that irradiate tumors at continuous low dose rate also can elicit immunostimulatory effects and represents a promising strategy to circumvent immune checkpoint inhibitor resistance. In this perspective, we discuss the accumulating preclinical and clinical data suggesting that activation of the immune system through the cGAS-STING axis and the release of extracellular vesicles by irradiated cells, participate to this antitumor immunity. This should need to be considered for adapting clinical practices to state of the art of the radiobiology and to increase targeted radionuclide therapy effectiveness.

中文翻译：

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靶向放射性核素治疗的免疫调节作用。

现在很清楚，传统放射治疗可以恢复细胞死亡的免疫原性。最近的临床前数据表明，以持续低剂量率照射肿瘤的靶向放射性核素治疗也可以引起免疫刺激作用，并且是规避免疫检查点抑制剂耐药性的有前途的策略。从这个角度来看，我们讨论了不断积累的临床前和临床数据，这些数据表明通过 cGAS-STING 轴激活免疫系统以及受照射细胞释放细胞外囊泡参与了这种抗肿瘤免疫。为了使临床实践适应放射生物学的最新技术并提高靶向放射性核素治疗的有效性，应该考虑这一点。