Integrating radiation therapy with targeted treatments for breast cancer: From bench to bedside. (July 2022) - Meattini, Icro
Highlights: Breast cancer therapeutic landscape has significantly evolved with an array of targeted therapies. Pivotal trials of new drugs did not include quality assurance in radiation therapy. Preclinical models are frequently not confirmed by clinical data. An overall low level of evidence on the safety data reported for populations treated with systemic therapy and concomitant radiation therapy exists. There is a lack of international consensus guidelines on how to integrate targeted agents with local treatments in both the curative and advanced settings. Abstract: Major advances have been made in precision medicine of breast cancer patients with a series of molecular targeted therapies now in clinical use or in late clinical development. These new therapeutic measures need to be integrated with local treatments, particularly with radiation therapy in both curative and advanced settings. Although a synergistic effect could be obtained between targeted therapies and irradiation, potential safety concerns should be carefully considered. At present, scarce evidence exists due to a lack of quality assurance on radiation therapy in pivotal trials of new drugs and missing reports on safety in case of concurrent radiation therapy, commonly administered with heterogenous doses and fractionations, especially in advanced disease. A major contribution for effectively combining radiation and targeted therapies in breast cancer could derive from clinically relevant preclinical studies. This review integrates preclinical and clinical evidence on how targeted agents and radiation therapy could be combined to help physicians in their daily clinical practice and to improve the clinical management of patients.