I was forced to dive headlong into understanding cancer therapy 2 1/2 years ago. It was obvious at the time that this was the correct direction to head, developing an entire therapeutic ecosystem to give the body every possible advantage and assail the disease with every possible disadvantage in order to get the desired outcome.
However, what I saw was a rather bizarre and disturbing fetish in the pharmaceutical and medical communities for ‘monotherapies’. I believe I understand the allure, if you find one thing that works, the proverbial silver bullet, that’s the best case scenario for treatment. It’s also quite obviously the best case for shareholders and investors, but let’s set that aside for now.
For the sake of future patients, I do hope that medicine and regulators deprioritize the search for monotherapies and receive the type of analysis represented in this article with open arms. In particular, I hope that the ’standard of care’ is given some flexibility so that doctors are able to adopt low risk adjunct therapies in order to improve outcomes and the amount of data available for continued research and improvement of treatment plans.
Re: monotherapies. This hasn't been my experience.
Almost all chemotherapy regimens are combination cocktails (e.g. R-CHOP, CMF, FOLFIRINOX, &c)
And as soon as a drug is shown to be very potent on its own (e.g. aPD1/aPDL1 checkpoint blockade) there's an explosion of trials looking to combine it with every possible other mechanism.
However, there is a strong desire to see drugs do something on their own before combining them with something else.
I've been impressed by the "therapudic ecosystem" developed for coronavirus in the absence of a 'monotherapy'. The MATH+ treatment is an effective combination of available drugs and vitamins. I hope any future COVID drug is used alongside these options, instead of a "here's an expensive drug, now go home!" Approach that some treatments take.
MATH+ seems to me like throwing everything and the kitchen sink into the disease, which screams “we don’t really know what we’re doing.” I haven’t seen replication efforts, and the doctor who’s peddling it once claimed to cure sepsis with IV vitamin C, an effort that failed to do much when replicated. It doesn’t look like a serious approach.
Monotherapies? The big thing for cancer treatment in the last decade has been targeted combination therapies. The anti-PDLs are a great example (and have really improved outcomes) and they are mostly layered on top of existing treatments.
However, what I saw was a rather bizarre and disturbing fetish in the pharmaceutical and medical communities for ‘monotherapies’. I believe I understand the allure, if you find one thing that works, the proverbial silver bullet, that’s the best case scenario for treatment. It’s also quite obviously the best case for shareholders and investors, but let’s set that aside for now.
For the sake of future patients, I do hope that medicine and regulators deprioritize the search for monotherapies and receive the type of analysis represented in this article with open arms. In particular, I hope that the ’standard of care’ is given some flexibility so that doctors are able to adopt low risk adjunct therapies in order to improve outcomes and the amount of data available for continued research and improvement of treatment plans.