Safety and Tolerability of Low Dose Radiotherapy Concurrent SBRT and PD-1 Inhibitors in Advanced NSCLC.

This pilot phase I trial aims to investigate the safety and tolerability of low dose radiotherapy (LDRT) and concurrent partial stereotactic body radiation therapy (SBRT) in combination with programmed cell death-1 (PD-1) inhibitors in Stage IV non-small cell lung cancer (NSCLC) patients who have failed standard therapy. At least 14 participants will be enrolled in this study. All will take part at West China Hospital, Sichuan University.

Inclusion Criteria:Be willing and able to provide written informed consent/assent for the trial.Be ≥18 years of age on day of signing informed consent.Patients with histologically or cytologically confirmed stage IV NSCLC.Be willing to undergo repeat biopsy of tumor lesions according to the study protocol.Patients who have failed the standard therapy, or who are unsuitable for standard treatment, or refuse chemotherapy.At least one measurable lesion according to RECIST 1.1. A lesion that has previously received radiotherapy can be considered a target lesion only if this lesion is clearly progressed after radiotherapy.The target lesions (irradiated lesions) are > 5cm in in diameterECOG 0-2.Life expectancy of > 3 months.Patients must have normal organ and bone marrow function as defined below: Total bilirubin </= 1.5 x upper limit of normal (ULN). Aminotransferase (AST) Serum Glutamic Oxaloacetic Transaminase (SGOT)/ Alanine Aminotransferase (ALT) Serum Glutamic-Pyruvic Transaminase (SGPT) <2.5 X institutional upper limit of normal (</= 5 X institutional ULN for subjects with liver metastases) *WBC >/= 3500/uL, ANC >/= 1500/uL *Platelets >/= 90K/ul *Hemoglobin >/= 9g/dL *Creatinine </= 1.5 x ULN, or creatinine clearance ≥ 50 ml/min（Cockcroft-Gault equation）. Coagulation: International Normalized Ratio (INR)≤ 1.5 × ULN, Partial thromboplastin time (PTT) ≤1.5 × ULN; left ventricular ejection fraction (LVEF) >/= 50% and QTcF (Fridericia's formula) ≤ 450msPatients has recovered (i.e., ≤ Grade 1 or at baseline) from adverse events due to a previously administered agent.Wash out period for chemotherapy is more than ≥ 4 weeks, for targeted small molecule therapy ≥ 5 half-lives; palliative radiotherapy must have been completed for at least ≥ 2 weeks, chest radiotherapy must have been completed for at least ≥ 4 weeks, and major surgery must have been completed for ≥ 4 weeks.Subjects with no severe pulmonary ventilation dysfunction, no acute heart failure, and no contraindication to radiotherapy as judged by the radiotherapist. Subjects who agree to receive immunotherapy and radiotherapy treatment.Subjects should agree to use an adequate method of contraception.Exclusion Criteria:Has known active central nervous system (CNS) metastases and/or carcinomatous meningitis and/or spinal cord compression, etc.With oncologic emergencies that require immediate treatmentEGFR/ALK/ROS-1 mutation or mutation status unknown.Has evidence of interstitial lung disease or active and/or non-infectious pneumonitis (drug-induced pneumonia, radiation-induced pneumonia, etc.) requiring steroid therapy.History of pulmonary fibrosis, pulmonary hypertension, severe irreversible airway obstruction diseasePatients with peripheral neuropathy.Significant heart disease or impairment of cardiac functionFluid accumulating in the third space, such as pericardial effusion, pleural effusion and peritoneal effusion that remains uncontrolled by aspiration or other treatmentKnown allergy to drugs or excipients, known severe allergic reaction to any of the PD-1 monoclonal antibodiesSevere infection within 4 weeks prior to the start of study treatment, including but not limited to hospitalization for infection, bacteremia, or severe pneumonia; treatment with oral or intravenous antibiotics within 2 weeks prior to the start of study treatment; patients receiving prophylactic antibiotic therapy (e.g., to prevent urinary tract infection or exacerbation of COPD) are eligible for this study.Known or suspected active autoimmune disease (congenital or acquired) such as uveitis, enterocolitis, hepatitis, pituitary inflammation, vasculitis, nephritis, thyroiditis, etc. (patients with vitiligo, or resolved childhood asthma may be enrolled; patients with type I diabetes with good insulin control may also be enrolled)Known allogeneic organ transplantation (except corneal transplantation) or allogeneic hematopoietic stem cell transplantation.