Concurrent use of chemotherapy or novel agents in combination with radiation in breast cancer

Treating breast cancer patients concurrently with chemotherapy and radiation is a potentially attractive approach. The goal is to develop strategies that enhance the effects of each modality while minimizing toxicity. Most data evaluating the role of simultaneous therapy have been generated from small phase 1 and 2 trials. As few prospective, randomized controlled trials have been performed in this area, generating definitive conclusions regarding the efficacy and toxicity from combined therapy remains difficult. This article reviews the current literature on the benefits and toxicities of concurrent radiation with cytotoxic chemotherapy, as well as with novel biologic agents such as monoclonal antibodies, tyrosine kinase inhibitors, and heat shock protein antagonists. Because the appropriate use of concurrent radiation with chemotherapy and biologic agents continues to evolve, we also highlight future and ongoing trials evaluating this treatment option.