Some good points longfellow, always enjoy your thoughtful posts.
As you know, the “combo is best” mantra is so prevalent because there hasn’t been a monotherapy that’s been able to increase survival in a large percentage of cancer patients, and of course, the influence of Big Pharma pushing this idea to increase their sales. Finding the right combination of toxic agents is proving difficult as they mostly tend to increase the toxicity without increasing efficacy. I think this will likely change though as the less toxic, personalized cell therapies that are coming through the pipeline now, are added to the market. (DC’s and NK’s for example)
I’m aware of your disdain of checkpoints, and I agree . . . to a point. They are clearly effective for some patients, and I think there is a place for them in cancer treatment, (certainly not the oversized role they now enjoy though) but there should be a far-greater effort to understand and minimize the hyperprogression and other adverse events. Unfortunately, to date, there hasn’t been a big enough incentive. Perhaps if competition from a more effective and less-toxic therapy comes along . . .
Interesting hypothesis. Do you think that if Dr. Liau believed as you do, that Prins would be able convince her? (that’s rhetorical) There’s some research (not just UCLA’s) to suggest the combination with DC’s may be more effective than either monotherapy, and it’s certainly worth testing with DCVax. (I suspect there is a subset of patients the combo may work for) In the case of rGBM, (or other terminal cancers) if the combo can add a few months of survival, even with the added risk of adverse events, I think it should be another option available for the patient to decide if it’s worth the risk. I’m guessing that for many it would be.
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