International multidisciplinary consensus on the integration of radiotherapy with new systemic treatments for breast cancer: European Society for Radiotherapy and Oncology (ESTRO)-endorsed recommendations.

Novel systemic therapies for breast cancer are being rapidly implemented into clinical practice. These drugs often have different mechanisms of action and side-effect profiles compared with traditional chemotherapy. Underpinning practice-changing clinical trials focused on the systemic therapies under investigation, thus there are sparse data available on radiotherapy. Integration of these new systemic therapies with radiotherapy is therefore challenging. Given this rapid, transformative change in breast cancer multimodal management, the multidisciplinary community must unite to ensure optimal, safe, and equitable treatment for all patients. The aim of this collaborative group of radiation, clinical, and medical oncologists, basic and translational scientists, and patient advocates was to: scope, synthesise, and summarise the literature on integrating novel drugs with radiotherapy for breast cancer; produce consensus statements on drug-radiotherapy integration, where specific evidence is lacking; and make best-practice recommendations for recording of radiotherapy data and quality assurance for subsequent studies testing novel drugs.

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Declaration of interests IMe declares participation in advisory boards supported by Eli Lilly, Novartis, Pfizer, Pierre Fabre, SeaGen, Daiichi Sankyo, and AstraZeneca. CB declares honoraria from Eli Lilly, and participation in advisory boards supported by Eli Lilly, Novartis, Pfizer, and Amgen. ML received honoraria from or participated in advisory boards for Roche, Novartis, Eli Lilly, Pfizer, AstraZeneca, Daiichi Sankyo, Gilead, SeaGen, Merck Sharp and Dohme, Exact Sciences, Takeda, Ipsen, Sandoz, Libbs, and Knight; received a travel grant from Gilead; and received research support for their institution from Gilead. EdA declares honoraria from or participation in advisory boards for Roche, Genentech, Novartis, SeaGen, Zodiac, Libbs, Pierre Fabre, Eli Lilly, and AstraZeneca. JC declares consulting or advisor roles supported by Roche, Celgene, Cellestia, AstraZeneca, SeaGen, Daiichi Sankyo, Erytech, Athenex, Polyphor, Eli Lilly, Merck Sharp and Dohme, GSK, Leuko, Bioasis, Clovis Oncology, Boehringer Ingelheim, Ellipses, Hibercell, BioInvent, Gemoab, Gilead, Menarini, Zymeworks, Reveal Genomics, and Expres2ion Biotechnologies. NH declares honoraria for lectures or consulting from AstraZeneca, Daiichi Sankyo, Gilead, Eli Lilly, Merck Sharp and Dohme, Novartis, Pierre Fabre, Pfizer, Roche, Sanofi, Sandoz, and SeaGen. HSR declares institutional research support from Astellas Pharma, AstraZeneca, Daiichi Sankyo, F Hoffmann-La Roche, Genentech, Gilead Sciences, GSK, Eli Lilly, Merck & Co, Novartis Pharmaceuticals Corporation, OBI Pharma, Pfizer, Pionyr Immunotherapeutics, Sermonix Pharmaceuticals, Taiho Oncology, and Veru. GC reports personal fees for consulting, advisory roles, and speakers’ bureau from Roche, Genentech, Novartis, Pfizer, Eli Lilly, Foundation Medicine, Samsung, and Daiichi Sankyo; honoraria from Ellipses Pharma; and fees for travel and accommodations from Roche, Genentech, and Pfizer. LV declares participation in advisory boards from Daiichi Sankyo and Pfizer. ME declares participation in advisory boards supported by Pfizer and Novartis, and lecture fees supported by AstraZeneca. TS declares participation in advisory boards supported by Bristol Myers Squibb, Merck Sharp and Dohme, Novartis, and Pierre Fabre; and lecture fees supported by Astellas, AstraZeneca, and Bristol Myers Squibb. GM declares consultancy honoraria from Roche, Novartis, AstraZeneca, Pfizer, Jensen, Eli Lilly, and Sanofi. LDM declares consulting fees from Roche, Novartis, Eli Lilly, Merck Sharp and Dohme, Daiichi Sankyo, SeaGen, Gilead, Eisai, Pierre Fabre, AstraZeneca, Stemline Menarini, Exact Sciences, Agendia, GSK, and Pfizer. MM declares consulting fees from Cedilla Therapeutics and PharmEnable, and research support from PharmaMar, Eli Lilly, Pfizer, and Circle Pharma. SP-S declares consulting fees from Pfizer, Novartis, Eli Lilly, AstraZeneca, Gilead, Merck, Sharp and Dohme, and Roche. BP declares consulting fees from Astra Zeneca, SeaGen, Gilead, Eli Lilly, Merck Sharp and Dohme, Daiichi Sankyo, and Pierre Fabre. CS declares consulting fees from AstraZeneca, Daiichi Sankyo, Eisai Europe, Gilead, Novartis, Pharmalex, Pfizer, Phillips Health Works, Pierre Fabre, PintPharma, Puma Biotechnology, Roche Farma, SeaGen, Solti, Synthon Biopharmaceuticals, and Zymeworks. All other authors declare no competing interests.