In a previous post, we spoke about the personalization of treatment, specifically in the treatment of cancer. As a follow-up, we note the importance of understanding how to best combine or sequence the treatments currently available and in development for the treatment of cancers. Historically, chemo-immunotherapy treatment regimens have combined many agents to effectively get patients into remission. With the new targeted non-chemotherapy agents, it is not yet known whether combinations will provide the best outcomes, both in terms of safety and efficacy.
Another challenge with the new non-chemotherapy agents is that they are very expensive and the cost of combinations may make them inaccessible to patients. In addition, the new agents are highly targeted, but often work on different pathways, which do not make them synergistic combination agents. There is the concern that when combined, these agents produce increased toxicities, sometimes with decreased efficacy.
As oncologists/hematologists have more targeted agents available to them, the patient outcomes and quality of life continue to improve from these treated with chemo-immunotherapy. However, for many patients remission does not last as long and additional treatments are required. This leaves oncologists/hematologists asking “What is the next agent I should pick? Will the patient respond?” The previous agent may have deteriorated some of the healthy cells that another inhibitor may have needed to be effective. The biology of the disease may have changed as a result of treatment and the next inline treatment may not be the best option any longer.
As with the personalization of treatment with these agents, the biology of the agent and the biology of the disease are very important to the effective use of these agents. As new drugs come to the market in the oncology space, oncologists/hematologists have only been able to test the tip of the iceberg. Hopefully, in 2-3 years as the number of patients treated with these agents increase, and patient experiences are understood, physicians will have certainty around how to combine and sequence.