Antibody drug conjugates (ADCs) are novel medications that combine monoclonal antibodies with cytotoxic payloads, enabling the selective delivery of potent drugs to cancer cells expressing specific surface antigens. This targeted strategy seeks to optimize treatment effectiveness while reducing the risk of systemic toxicity, distinguishing ADCs from conventional chemotherapy. The rapid growth in ADC research has led to numerous developments and approvals for cancer treatment, with significant impacts on the management of breast cancer. ADCs like T-DXd for HER2-low disease and sacituzumab govitecan for triple negative breast cancer (TNBC) have provided valuable options for challenging subtypes of breast cancer. However, essential questions still need to be addressed, including the optimal order of ADCs amidst the growing number of newly developed ones and strategies to overcome resistance mechanisms. Preclinical studies have shed light on potential resistance mechanisms, emphasizing the potential benefit of combinational approaches with other agents such as immune checkpoint inhibitors (ICIs) and targeted tyrosine kinase inhibitors (TKIs) to enhance treatment effectiveness. Additionally, personalized approaches based on molecular profiling hold promise in tailoring ADC treatments to individual tumors, identifying unique molecular markers for each patient to optimize treatment efficacy while minimizing side effects.

In drug-drug interactions, there are surprising cases in which the growth inhibition of bacteria by a single antibiotic decreases when a second antibiotic is added. These interactions are termed suppressive and have been argued to have the potential to limit the evolution of resistance. Nevertheless, little attention has been given to suppressive interactions because clinical studies typically search for increases in killing efficiency and because suppressive interactions are believed to be rare based on pairwise studies. Here, we quantify the effects of single-, double-, and triple-drug combinations from a set of 14 antibiotics and 3 bacteria strains, totaling 364 unique three-drug combinations per bacteria strain. We find that increasing the number of drugs can increase the prevalence of suppressive interactions: 17% of three-drug combinations are suppressive compared to 5% of two-drug combinations in this study. Most cases of suppression we find (97%) are “hidden” cases for which the triple-drug bacterial growth is less than the single-drug treatments but exceeds that of a pairwise combination. We find a surprising number of suppressive interactions in higher-order drug combinations. Without examining lower-order (pairwise) bacterial growth, emergent suppressive effects would be missed, potentially affecting our understanding of evolution of resistance and treatment strategies for resistant pathogens. These findings suggest that careful examination of the full factorial of drug combinations is needed to uncover suppressive interactions in higher-order combinations.

Background: Metastasis of solid tumors to the tongue is a rare occurrence and makes up less than 1% of head and neck cancers. Given the treatment approach for a primary head and neck cancer would differ from metastasis to the tongue, an accurate diagnosis is critical. There are only a few reported cases of pancreatic cancer metastasizing to the head and neck region. Case Description: This report presents a unique case of a 91-year-old man who initially presented with a painful tongue mass and ultimately was found to have metastatic pancreatic ductal adenocarcinoma. Comparison of a biopsy from the tongue mass and the pancreatic lesion showed they were morphologically identical and confirmed the diagnosis. Treatment of the tongue lesion with palliative radiation led to clinical improvement of difficulty and pain with swallowing. Conclusions: Our case highlights a rare presentation of pancreatic cancer, as metastasis to the tongue has not been previously described as an initial presentation of pancreatic cancer. This report also discusses potential treatment strategies for this unique presentation. Head and neck lesions can greatly impact oral intake. Use of radiation therapy (RT) appears to alleviate some of these symptoms and lead to improved nutrition. Practitioners should consider palliative radiation as a potential treatment strategy in patients with tongue metastases.