Combining Targeted Drugs and Radiation in Breast Cancer: What's Safe?

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Combining Targeted Drugs and Radiation in Breast Cancer: What's Safe?
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There are surprisingly little data on how to safely combine new targeted treatments for breast cancer alongside radiotherapy. Experts weigh in on what we know.

contributor and professor of oncology and medicine at the Indiana University School of Medicine, Indianapolis, Indiana.

Below is a guide to what we do and don't know about combining radiotherapy and systemic treatments in breast cancer.Safety data on combining immune checkpoint inhibitors and radiotherapy in breast cancer are limited because concurrent radiotherapy has typically been excluded in pivotal trials.trial did provide a rare look at concurrent radiotherapy and immunotherapy in early triple-negative breast cancer.

"These findings suggest that the simultaneous administration of CDK4/6 inhibitors and radiotherapy is generally well tolerated," the ESTRO authors concluded but added that CDK4/6 inhibitors and concomitant radiotherapy should be investigated more in the adjuvant locoregional, whole brain, and intracranial stereotactic radiotherapy settings.

Because of potential good or bad interactions between new systemic therapies and radiotherapy, "intentional trial design" is important, Jagsi said, so we "know the best way to combine treatments in practice to optimize outcomes." Clinical trial data on the safety of combining PI3K and mTOR inhibitors with radiation are thin, especially in advanced breast cancer. Typically, radiotherapy within 4 weeks before randomization, or 2 weeks for palliative radiation, was excluded in pivotal trials.

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