Better together.

While it is true huge strides have been achieved in recent years when it comes to treating breast cancer, many of these leaps have left behind women with the worst disease. Such women are the subject of a phase II trial reported in Red Journal this summer, including chemo-refractory inoperable, residual postoperative, unresectable recurrent, and oligometastatic disease. All patients received 54-57 Gy to the breast/chest wall and regional nodes with additional boost to  66-72 Gy to gross disease...all concurrent with capecitabine. Despite a 73% response rate, survival at one year was a dismal 53% with half of patients with triple-negative disease failing to live past 5 months. Two less dismal takeaways: concurrent capecitabine and radiation appear to be (1) effective at reducing gross disease and (2) safe to be given in combo. The latter point is particularly important in the context of the recent CREATE-X trial where we were left wondering how best to sequence adjuvant capecitabine with more established adjuvant radiation. Perhaps the answer is to not sequence at all.