Medical Oncology

, 36:4 | Cite as

Radiotherapy with the anti-programmed cell death ligand-1 immune checkpoint blocker avelumab: acute toxicities in triple-negative breast cancer

  • Eliana La Rocca
  • Michela Dispinzieri
  • Laura Lozza
  • Gabriella Mariani
  • Serena Di Cosimo
  • Massimiliano Gennaro
  • Riccardo Valdagni
  • Maria Carmen De SantisEmail author
Short Communication


Triple-negative breast cancer (TNBC) is clinically the most aggressive breast cancer (BC) subtype. There is an urgent need for effective therapies for patients with TNBC. Recent findings confirm the important role of factors related to the immune system in the clinical outcome and response to treatment of TNBC patients. Avelumab selectively binds to PDL1, and competitively blocks its interaction with anti-programmed death 1 (anti-PD-1) antibodies. Unlike anti-PD-1 antibodies, which target T-cells, avelumab targets tumor cells, and is therefore expected to have fewer side effects, including a lower risk of Immune-Related Adverse Events (irAEs). Uncertainties remain regarding a potential synergy resulting in increased toxicities by combining radiotherapy and immune-checkpoint inhibitors (ICIs). Effects of concomitant ICIs with thoracic radiotherapy on pulmonary toxicities is not currently known. There are no published data available on the effects of combining anti-PD-L1 with adjuvant radiotherapy (RT) for BC in a clinical setting. We reported a preliminary experience on the first patient treated at the National Cancer Institute of Milan with the association of avelumab and concomitantly RT for TNBC.


Breast cancer Concomitant radiotherapy Immunotherapy Safety Pulmonary toxicity 



The Authors would like to thank Prof. P. Conte and Prof. V. Guarneri, the PI and co-PI behind this study.

Compliance with ethical standards

Conflict of interest

we have no conflicts of interest to disclose.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The present study has been reviewed and approved by the Ethical Review Board of the National Cancer Institute, Italy.

Informed consent

Informed consent for publication of this case study was obtained from the patient concerned.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Eliana La Rocca
    • 1
    • 2
  • Michela Dispinzieri
    • 1
    • 2
  • Laura Lozza
    • 1
  • Gabriella Mariani
    • 3
  • Serena Di Cosimo
    • 4
  • Massimiliano Gennaro
    • 5
  • Riccardo Valdagni
    • 6
  • Maria Carmen De Santis
    • 1
    Email author
  1. 1.Radiotherapy Unit 1Fondazione IRCCS Istituto Nazionale dei TumoriMilanItaly
  2. 2.Department of Oncology and Hemato-oncologyUniversità degli Studi di MilanoMilanItaly
  3. 3.Department of OncologyFondazione IRCCS Istituto Nazionale dei TumoriMilanItaly
  4. 4.Department of Applied Research and Technological Development (DRAST)Fondazione IRCCS Istituto Nazionale dei TumoriMilanItaly
  5. 5.Breast Surgery UnitFondazione IRCCS Istituto Nazionale dei TumoriMilanItaly
  6. 6.Department of Oncology and Hemato-oncology, Radiation Oncology 1 and Prostate Cancer ProgramUniversità degli Studi di Milano, Fondazione IRCCS Istituto Nazionale dei TumoriMilanItaly

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