The Future of Pancreatic Cancer

Medical oncologist Dr. Mark H. O’Hara explains how research on innovative immunotherapy therapies at Penn may offer hope to current and future pancreatic cancer patients.

Denise’s Story

When Denise found herself diagnosed with cancer for a second time in her young life, she found comfort in the many cancer treatment and fertility preservation options available to her at Penn Medicine. Read about her journey and the research studies that are giving her hope for her future.

Am I at Risk of Breast Cancer?

Read common questions and answers about how a woman can manage her personal risk of breast cancer.

Genetic Testing and Family History Help Determine Cancer Risk

Learn about the BRCA gene mutations, as well as life-saving options for those with a family history or genetic risk of cancer.

Combination Therapy and the Evolution of Resistance: The Theoretical Merits of Synergism and Antagonism in Cancer

The search for effective combination therapies for cancer has focused heavily on synergistic combinations because they exhibit enhanced therapeutic efficacy at lower doses. Although synergism is intuitively attractive, therapeutic success often depends on whether drug resistance develops. The impact of synergistic combinations (vs. antagonistic or additive combinations) on the process of drug-resistance evolution has not been investigated. In this study, we use a simplified computational model of cancer cell numbers in a population of drug-sensitive, singly-resistant, and fully-resistant cells to simulate the dynamics of resistance evolution in the presence of two-drug combinations. When we compared combination therapies administered at the same combination of effective doses, simulations showed synergistic combinations most effective at delaying onset of resistance. Paradoxically, when the therapies were compared using dose combinations with equal initial efficacy, antagonistic combinations were most successful at suppressing expansion of resistant subclones. These findings suggest that, although synergistic combinations could suppress resistance through early decimation of cell numbers (making them “proefficacy” strategies), they are inherently fragile toward the development of single resistance. In contrast, antagonistic combinations suppressed the clonal expansion of singly-resistant cells, making them “antiresistance” strategies. The distinction between synergism and antagonism was intrinsically connected to the distinction between offensive and defensive strategies, where offensive strategies inflicted early casualties and defensive strategies established protection against anticipated future threats. Our findings question the exclusive focus on synergistic combinations and motivate further consideration of nonsynergistic combinations for cancer therapy.Significance: Computational simulations show that if different combination therapies have similar initial efficacy in cancers, then nonsynergistic drug combinations are more likely than synergistic drug combinations to provide a long-term defense against the evolution of therapeutic resistance. Cancer Res; 78(9); 1–13. ©2018 AACR.