Drugs that lack single-agent activity: are they worth pursuing in combination?

Over the past decade, many anticancer drugs have been approved for use only in combination regimens and only in palliative settings, despite having negligible single-agent activity in the same disease. We examine whether these agents provide any tangible clinical benefits and are worthy of continued development, or whether R&D efforts would be better focused elsewhere.

Access options

Rent or Buy article

Get time limited or full article access on ReadCube.


All prices are NET prices.


  1. 1

    Zonder, J. A. et al. A phase 1, multicenter, open-label, dose escalation study of elotuzumab in patients with advanced multiple myeloma. Blood 120, 552–559 (2012).

    CAS  Article  Google Scholar 

  2. 2

    Wolf, J. L. et al. Phase II trial of the pan-deacetylase inhibitor panobinostat as a single agent in advanced relapsed/refractory multiple myeloma. Leuk. Lymphoma. 53, 1820–1823 (2012).

    CAS  Article  Google Scholar 

  3. 3

    Blackwell, K. L. et al. Single-agent lapatinib for HER2-overexpressing advanced or metastatic breast cancer that progressed on first- or second-line trastuzumab-containing regimens. Ann. Oncol. 20, 1026–1031 (2009).

    CAS  Article  Google Scholar 

  4. 4

    Ocaña, A., Amir, E., Vera, F., Eisenhauer, E. A. & Tannock, I. F. Addition of bevacizumab to chemotherapy for treatment of solid tumors: similar results but different conclusions. J. Clin. Oncol. 29, 254–256 (2011).

    Article  Google Scholar 

  5. 5

    Sledge, G. W. et al. Phase III trial of doxorubicin, paclitaxel, and the combination of doxorubicin and paclitaxel as front-line chemotherapy for metastatic breast cancer: an intergroup trial (E1193). J. Clin. Oncol. 21, 588–592 (2003).

    Article  Google Scholar 

  6. 6

    Gyawali, B. & Prasad, V. Same data; different interpretations. J. Clin. Oncol. 34, 3729–3732 (2016).

    CAS  Article  Google Scholar 

  7. 7

    Inman, S. ODAC votes against panobinostat in multiple myeloma. OncLive http://www.onclive.com/web-exclusives/odac-votes-against-panobinostat-in-multiple-myeloma (2014).

    Google Scholar 

  8. 8

    Dimopoulos, M. et al. Vorinostat or placebo in combination with bortezomib in patients with multiple myeloma (VANTAGE 088): a multicentre, randomised, double-blind study. Lancet Oncol. 14, 1129–1140 (2013).

    CAS  Article  Google Scholar 

  9. 9

    Orlowski, R. Z. et al. Final overall survival results of a randomized trial comparing bortezomib plus pegylated liposomal doxorubicin with bortezomib alone in patients with relapsed or refractory multiple myeloma. Cancer 122, 2050–2056 (2016).

    CAS  Article  Google Scholar 

Download references

Author information



Corresponding author

Correspondence to Vinay Prasad.

Ethics declarations

Competing interests

The authors declare no competing financial interests.

Supplementary information

Supplementary information S1 (table)

Approvals of drugs with limited evidence of single-agent activity as combination therapies (DOC 53 kb)

PowerPoint slides

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Gyawali, B., Prasad, V. Drugs that lack single-agent activity: are they worth pursuing in combination?. Nat Rev Clin Oncol 14, 193–194 (2017). https://doi.org/10.1038/nrclinonc.2017.27

Download citation

Further reading