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Which targeted systemic agents should be held while delivering palliative radiation?
If the systemic agent is going to be held, how many days prior to starting radiation therapy should the agent be held and when can it be restarted after radiation? What general principles do you apply to sequencing these such agents with palliative radiation courses (especially for the newer agents without published evidence on radiosensitization)? Are there chemotherapy drugs that should be held (e.g. cisplatin, when giving a hypofractionated course of pallitive radiation (e.g. 20Gy in 5fx)?
Answer from: Radiation Oncologist at Community Practice
Great question regarding the use of systemic therapy for cancer during palliative radiation. First, regarding targeted therapies, there are no reports of targeted therapies which would be unsafe or should be held during palliative radiotherapy. Most targeted agents are monoclonal antibodies to rec...
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Answer from: Radiation Oncologist at Community Practice
I'm not sure if this case was published, but I am aware of a case of Gr3-4 dermatitis after a few fractions of palliative RT in a patient taking Vemurafanib. This was shortly after FDA approval of the drug.
It seemed like a clear case of radiosensitizing.
Answer from: Radiation Oncologist at Community Practice
Here is a good review article on BRAF inhibitor and enhanced RT toxicity.