3. Discussion
toxicity, cancer, adenocarcinoma
CANCER, CERVICAL CANCER, ADENOCARCINOMA
To our knowledge, this is the first clinical trial to combine CIRT and durvalumab. Although many clinical trials on the combination of RT and ICI have been conducted, this is the first clinical trial to combine CIRT and ICI in the world, and the concurrent use of ICI and CIRT is also highly novel. All three patients achieved CR within the CIRT region, and none developed DLT. Although only three patients were included, the combination of chemo-CIRT and durvalumab appears promising, considering its initial efficacy and safety profile.There is no doubt that ICIs are effective against many types of cancer. In addition, the clinical significance of the combination of ICI and RT is gaining support [Although CIRT has been suggested to be more effective than conventional RT in treating cervical cancer, particularly adenocarcinoma [Although the study enrolled only three patients, all patients completed the scheduled treatment and did not develop DLT. Thus, by combining chemo-CIRT and anti-PD-L1 antibodies, our treatment strategy was considered tolerable. A recent meta-analysis of toxicity in a regimen combining ICIs and RT found that the incidence of grade 3–4 toxicity was comparable to an ICI-alone regimen [The primary limitation of this study is the small number of patients, only three patients; while the impact of COVID-19 on patient aggregation was discouraging, validation in a larger number of patients may be warranted. A phase II trial with a larger number of patients is desired in the future. Another limitation is the possibility of bias due to favorable performance status, as well as the fact that the study was conducted in a single country. Currently, only a few centers offer CIRT, though this number is steadily increasing. CIRT combined with chemotherapy containing ICI will be available in many centers in the future.