Rotate between drugs on a fixed schedule instead of waiting for failure
Hospitals rotate antibiotics to stop bacteria adapting. Cycling between two cancer drugs on a set schedule, rather than using one until it fails, might work the same way.
Antibiotic cycling and mixing are used to manage resistance in intensive care, with mathematical models predicting when each is superior. In oncology, drugs are almost always given until failure. Where two agents with non-overlapping resistance mechanisms and tolerable toxicity exist, scheduled rotation before resistance is established could keep both populations suppressed. Modelling should precede the trial to choose cycle length.
- Acquired resistance to every therapy · Nearly every targeted therapy stops working within months to a few years as the tumour adapts.
- Too many combinations to test · There are thousands of possible drug pairs and sequences. Trials can test a few dozen a year.
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