|Fig 5 of Bozic et al.|
The key figure (for me) is Fig 5 which shows that if there is even a single mutation that confers cross-resistance to both drugs, then sequential therapy will fail in all cases (A). With simultaneous therapy, 26.3% of patients can be cured under the same circumstances. In the remaining patients (73.7%), cross-resistant mutations existed prior to the therapy and their expansive growth will ensure treatment failure whether treatment is simultaneous or sequential (B). If the two drugs have no resistance mutations in common (n12 = 0), then simultaneous therapy is successful with a probability of 99.9% (D) while sequential therapy still fails in all cases (C).
It is a beautiful classic in the application of Evolutionary Dynamic calculations to real medical problems.
Daughter coming home today - turns out that her First in her history finals was very solid indeed, and her results were well inside the top 10% of her year. We're organising another Colloquium on the Ethical and Spiritual Implications of the Internet tonight at the House of Lords, with Onora O'Neill charing and Vittorio Colao and Rowan Williams as initial speakers, so no time to blog in detail.