Emerging treatments

Tucatinib

The addition of tucatinib, a small molecule HER2 kinase inhibitor, to capecitabine and trastuzumab can prolong progression-free survival in patients with advanced HER2-positive breast cancer.[417] The European Medicines Agency has approved tucatinib for treatment of locally advanced and metastatic HER2-positive breast cancer.

Lapatinib

Lapatinib, an oral dual tyrosine kinase inhibitor, improved pathological complete response when used as neoadjuvant HER2-targeted therapy (as a single agent or combined with trastuzumab) in phase 3 trials of patients with HER2-positive invasive breast cancer.[418][419] Lapatinib is associated with significant adverse events such as diarrhoea, rash, and liver test abnormalities.[418]

Eganelisib

Phase 2 trials are investigating the addition of the checkpoint inhibitor eganelisib to chemotherapy for triple-negative, locally advanced, inoperable breast cancer.[420] Eganelisib has been granted fast track designation by the US Food and Drug Administration (FDA).

Partial breast irradiation with intraoperative radiotherapy

Intraoperative radiotherapy may allow radiotherapy with reduced toxicity to be completed at the same time as lumpectomy in highly selected patients with early breast cancer. However, studies suggest it may be associated with a higher rate of recurrence compared with whole-breast radiotherapy (with comparable overall mortality).[378][421][422]​ Guidelines recommend that intraoperative radiotherapy for partial breast irradiation is used only as part of a clinical trial.[362][423] Further research is needed to optimise patient selection criteria and treatment techniques.​​​​

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