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Chemotherapy is the milestone of cancer therapy in the past decades. Next-generation chemotherapy introduces innovative methods that enhance existing drugs and develop new therapeutic platforms aimed at improving effectiveness and reducing side effects by precisely targeting cancer cells. This includes modifications of established drugs, the use of engineered delivery systems like antibody-drug conjugates (ADCs), and the creation of new drug classes such as bispecific antibodies. Notable examples of ADCs are trastuzumab deruxtecan and sacituzumab govitecan (SG) for breast cancer treatment, while amivantamab serves as an example of a bispecific antibody in treating lung cancer. These cutting-edge options not only boost the effectiveness of traditional chemotherapy but also lessen side effects, thus enhancing patients' quality of life.

Immunotherapy is a treatment that stimulates the immune system, which normally defends the body from infection, to recognize and eliminate cancer cells. Malignancy is a disease that can evade the immune system by hiding from T-cell and B-cell checkpoints.

The most common type is the checkpoint Inhibitor. There are other kinds, including Adoptive Cell Therapy (CAR T-Cell Therapy), Bispecific T-cell Engagers, Cytokine Therapy, Monoclonal Antibodies, Oncolytic Virus Therapy, and Therapeutic Vaccines.

Immunotherapy has shown effectiveness in more than 20 types of cancer, either as an approved FDA treatment or in promising clinical trials.

Hormonal therapy, once seen as supplementary, has now taken center stage, providing robust strategies to disrupt the signals that promote cancer growth.

Androgen deprivation therapy (ADT) has long been a fundamental approach in managing prostate cancer by targeting the male hormones that stimulate tumor growth. Recent innovations have introduced new agents such as second-generation anti-androgens, including enzalutamide and abiraterone, which offer a more effective blockade of androgen signaling pathways.

In breast cancer, hormonal therapy has become an indispensable strategy, especially for hormone receptor-positive tumors, which represent a significant portion of cases. The new treatment landscape includes advanced therapies like selective estrogen receptor modulators (SERMs) such as tamoxifen and aromatase inhibitors like letrozole, which effectively inhibit estrogen's influence on tumor growth. These therapies can significantly lower the risk of recurrence and enhance survival rates. Furthermore, the introduction of targeted therapies like CDK4/6 inhibitors, which work in synergy with hormonal treatments, has further boosted treatment effectiveness. Breast cancer treatment is tailored to the patient's specific tumor characteristics and biology, and integrating genomic profiling into treatment plans enables personalized hormonal therapy.

Image-guided radiation therapy (IGRT) is an advanced technique that integrates imaging, such as X-rays, CT, or MRI scans, into radiotherapy to improve localization accuracy and precision of treatment.

IGRT allows clinicians to adjust the patient’s position and the treatment plan in real time. This approach allows continuous monitoring of tumor position, size, and shape during the treatment course. Hence, IGRT can reduce setup errors, enable tighter treatment margins, and increase the effectiveness of radiation therapy with fewer side effects.

Before each treatment session, the patient is positioned on the treatment couch according to the treatment plan with the aid of in-room lasers. Then, images are taken with an imaging system before or during the treatment. By comparing these images to the reference images taken during simulation. The patient’s position may be adjusted if necessary to ensure the tumor receives the intended radiation dose while minimizing radiation exposure to healthy surrounding tissues.

IGRT is particularly important for tumors that may move between treatments or are close to critical healthy organs. IGRT is essential in radiotherapy treatments with high precision requirements, such as intensity modulated radiotherapy (IMRT), stereotactic radiosurgery (SRS), stereotactic body radiotherapy (SBRT).

Stereotactic Body Radiation Therapy (SBRT) is a recent advanced radiotherapy technique. Compared with conventional radiotherapy, it aims to deliver a high dose of radiation to treat tumours in fewer treatment fractions. The potential sites of tumours in which SBRT is used include tumours in the body, such as lung, bone, liver and prostate malignancies.

SBRT demands precise and accurate delivery, as higher doses of radiation are delivered. This requires accessory tools and techniques, including advanced patient immobilisation and motion/tumour tracking devices to increase patient stability during treatment. Some of these devices include an abdominal compression device, an Active Breathing Control device, and fiducial marker implants. In addition, positional verification before each treatment is obtained by volumetric imaging showing anatomies of interest. SBRT can be integrated with several techniques, such as tomotherapy, image-guided intensity-modulated radiation therapy (IMRT), and volumetric modulated arc therapy (VMAT). The latest machines, MR Linacs, can also be applied in this technique