Advances in photodynamic therapy and its combination strategies for breast cancer

Breast cancer remains one of the leading causes of cancer-related mortality worldwide, with treatment resistance and recurrence posing significant challenges to conventional therapies such as chemotherapy, surgery, and radiotherapy. Photosensitiser-assisted treatment strategies, particularly photodynamic therapy (PDT), have emerged as a promising alternative for breast cancer due to its targeted nature and minimally invasive approach. This review provides an overview of PDT as a treatment strategy for breast cancer. We begin by discussing the current therapeutic approaches and their limitations in breast cancer management. We then examine the principles and mechanisms underlying PDT, along with various delivery systems employed to enhance its efficacy, including liposomes, extracellular vesicles, gold nanoparticles and lipid-polymer hybrid nanoparticles. Furthermore, we highlight the recent advances in PDT-based combination therapies and their progress in clinical development. Finally, we identify the key remaining challenges and outline potential future research directions with a particular focus on AI integration, to improve therapeutic outcomes for breast cancer patients. STATEMENT OF SIGNIFICANCE: Conventional treatments for breast cancer severely affect the therapeutic effects, particularly for aggressive and treatment-resistant subtypes. Photodynamic therapy (PDT) has emerged as a promising, minimally invasive alternative that enables selective tumour targeting. In the past three years, several reviews in this area have been published focusing on inorganic nanoparticles-based PDT and preclinical studies, which is a fairly narrow focus in the field of PDT for breast cancer. Our review addresses this gap by summarising the most recent developments in both preclinical and clinical applications of PDT for breast cancer, with a particular focus on its use in combination with other therapeutic modalities. We also explore future directions, including the integration of artificial intelligence to enhance treatment precision. This timely and broad-scope review is expected to attract wide interest from researchers, clinicians and industry stakeholders aiming to advance breast cancer therapies.