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Optimización de la radioterapia de puente previa a la terapia de células CAR-T: un enfoque basado en la evidencia
Pierre Loap1, Clémentine Sarkozy2, Remi Dendale3
1Proton Therapy Center, Institut Curie, Orsay, France; Curie Radiotherapy Department, Institut Curie, Paris, France; Laboratoire d'Imagerie Translationnelle en Oncologie, Institut Curie, Orsay, France.
Critical reviews in oncology/hematology
|February 6, 2026
Resumen
La radioterapia de puente optimiza la terapia de células T con receptores de antígenos quiméricos (CAR-T) para cánceres de la sangre al controlar la enfermedad y mejorar la respuesta inmune. Esta estrategia mejora los resultados de los pacientes al integrar la radioterapia con la infusión de CAR-T.
Área de la Ciencia:
- Oncología
- Inmunoterapia
- Oncología de Radiación
Sus antecedentes:
- La radioterapia de puente es crucial para el manejo de neoplasias hematológicas en recaída/refractarias antes de la terapia CAR-T.
- Controla la carga tumoral y mantiene la estabilidad entre la leucoféresis y la infusión de CAR-T, previniendo la progresión tumoral.
Objetivo del estudio:
- Esbozar proposiciones basadas en la evidencia para integrar la radioterapia de puente en los protocolos de terapia CAR-T.
- Proporcionar un marco para optimizar el momento, la fraccionamiento y la entrega de la radioterapia para mejorar los resultados de los pacientes.
Principales métodos:
- Revisión de la evidencia de estudios de linfoma y mieloma múltiple.
- Análisis del papel de la radioterapia en el control de la enfermedad y la inmunomodulación.
- Desarrollo de proposiciones prácticas para el flujo de trabajo, el fraccionamiento y los enfoques técnicos.
Principales resultados:
- La radioterapia hipofraccionada demuestra eficacia en linfomas (p. ej., DLBCL) y muestra promesa en el mieloma múltiple.
- La radioterapia puede mejorar la eficacia de CAR-T a través de efectos inmunomoduladores, pero se deben controlar los riesgos de inmunosupresión.
- La integración óptima implica una sincronización precisa, una planificación/entrega rápidas y la coordinación del equipo.
Conclusiones:
- La radioterapia de puente es una estrategia valiosa para mejorar la eficacia de la terapia CAR-T en neoplasias hematológicas.
- La planificación y ejecución cuidadosas son esenciales para maximizar los beneficios y minimizar la toxicidad.
- Este marco facilita la incorporación de la radioterapia, con el objetivo de mejorar el control de la enfermedad y la inmunidad antitumoral sinérgica.
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