Dr. Shankar Siva: combination of immunotherapy and stereotactic ablative radiotherapy may be a better choice for cancer patients

Editor’s note

The 10^th Shanghai International Conference on Radiation Oncology, SICRO X was held on August 11, 2018 in Shanghai, China. Numerous outstanding experts around the world attended the conference, bringing up-to-date information about promoting patient-oriented and data-based radiotherapy in the treatment of lung cancer and esophagus cancer.

Before the conference, the Editorial Office of Precision Cancer Medicine is honored to make an interview with Dr. Shankar Siva via email, sharing his experience among the peer regarding radiotherapy and immunotherapy in cancer treatment.

Expert introduction

Dr. Shankar Siva (Figure 1) is a Radiation Oncologist and NHMRC fellow at the Peter Mac and leads the Stereotactic Ablative Body Radiotherapy (SABR) program and Australia's first dedicated SABR clinic. He completed his PhD with the Molecular Radiation Biology (Martin) Laboratory focusing on translational investigations in precision high-dose lung radiotherapy. He published the first original research from Australia on the use of the SABR technique. Dr. Siva leads multiple clinical trials in the treatment of lung and urological cancers at the Peter Mac, and is chair of three TransTasman Radiation Oncology Group (TROG) studies in the fields of oligometastases, lung and kidney cancers. He is Co-Chair of the TROG Genitourinary Group, is an executive member of Radiation Oncology Research Committee (RORC) of the Royal Australian and New Zealand College of Radiologists (RANZCR) and Management Advisory Committee (MAC) of the Australasian Lung Cancer Trials Group (ALTG) amongst other leadership roles. He has research interests in high-tech radiotherapy delivery, radiation biology and radiation immunology.

Figure 1 Dr. Shankar Siva.

Interview

PCM: Your speech topic is “Immunotherapy and ablative radiotherapy, a partnership for life”. Why do you think the combination of immunotherapy and stereotactic ablative radiotherapy (SABR), which is known as I-SABR, would be a better choice for cancer patients?

Dr. Siva: Radiotherapy has long been known to have inflammatory and immune stimulating properties at the site of the irradiated tumour. We are all excited about the new era of immunotherapies for our cancer patients, but at present, the majority of patients do not respond to these therapies. In this context, stereotactic ablative radiotherapy (SABR), represents an inexpensive, low-toxicity and potentially effective adjunct to boost the efficacy of immunotherapies.

PCM: In what situations could we choose I-SABR? Would you share some successful cases?

Dr. Siva: A possible scenario would be to treat with radiotherapy a symptomatic site of disease at the beginning of the introduction of immunotherapy. Another scenario would be to give consolidation SABR to sites of disease that have not responded to initial immunotherapy. We are all still learning about this exciting combination therapies, and despite being a quite new treatment approach, I am cautiously optimistic about some of the impressive results that have been documented so far.

PCM: What are the main challenges when promoting this therapy? And how to overcome them?

Dr. Siva: We need more evidence from well conducted clinical trials to firmly establish this combination treatment approach. The science will always speak for itself, so a lot of my efforts are directed towards conducting clinical trials with this treatment combination.

PCM: As we know, you published the first original research from Australia on the use of the SABR technique. Now you are dedicated to promoting I-SABR. It is always tough to be pioneers. What encouraged you to do so?

Dr. Siva: I think it’s always invigorating to push the boundaries of what we can do in medicine, with the goal to improve the outcomes for our patients. I’m genuinely excited that by contributing to developing new treatment approaches, I’m helping people suffering from cancer.

PCM: With all your successful roles both in research and society committees, what would be your advice to balance one’s time?

Dr. Siva: I am still trying to find the right balance! It is very difficult, particularly with a young family as well. I have a wonderfully supportive wife and we work as a team to support my efforts in cancer research. In terms of advice, I think it is important to look at all potential opportunities seriously, work hard and then the rest should follow.

Acknowledgments

On behalf of the editorial office of Precision Cancer Medicine, I would like to express our sincerest gratitude to Dr. Shankar Siva for sharing his insights and opinions with us.

Funding: None.

Footnote

Provenance and Peer Review: This article was commissioned by the editorial office, Precision Cancer Medicine. The article did not undergo external peer review.

Conflicts of Interest: The author has completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/pcm.2018.08.03). GL is a full-time employee of AME Publishing Company (publisher of the journal). The author has no other conflicts of interest to declare.

Ethical Statement: The author is accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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(Science Editor: Gin Li, PCM, pcm@amegroups.com)