We have another ESTRO-ESMO consensus statement on combining radiation with novel systemic therapies. While the last touched on immunotherapies, VEGF-inhibitors and TKIs, this one talks all things CDK4/6, HER2, PARP, or mTOR inhibitors. In general, no adaptations are need in conjunction with anti-HER2 therapies. In contrast, CDK4/6 inhibitors, PARP inhibitors, and mTOR inhibitors frequently warrant caution, with recommendations ranging from dose modification to outright avoidance—particularly for concurrent high-dose radiation to thorax, abdomen/pelvis, or head and neck, mucosal toxicities have been reported. Most noteworthy, PARP inhibitors stood out for consistent radiosensitization even at low doses, earning “major adaptation” across essentially all scenarios. | van Aken, Radiother Oncol 2025
