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Combination Cancer Therapy
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By Bruce A. Chabner, MD, Director of Clinical Research, Massachusetts General Hospital Cancer Center; Professor of Medicine, Harvard Medical School Elizabeth Chabner Thompson, MD, MPH, Founder, BFFL Co

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Combination Cancer Therapy

Chemotherapy drugs are most effective when given in combination (combination chemotherapy). The rationale for combination chemotherapy is to use drugs that work by different mechanisms, thereby decreasing the likelihood that resistant cancer cells will develop. When drugs with different effects are combined, each drug can be used at its optimal dose, without intolerable side effects.

For some cancers, the best approach is a combination of surgery, radiation therapy, and chemotherapy. Surgery or radiation therapy treats cancer that is confined locally, while chemotherapy also kills the cancer cells that have spread to distant sites. Sometimes radiation therapy or chemotherapy is given before surgery to shrink a tumor, thereby improving the opportunity for complete surgical removal. Radiation therapy and low-dose chemotherapy after surgery help to destroy any remaining cancer cells. The stage and type of the cancer often determines whether single therapy or combination therapy is needed. For example, early-stage breast cancer may be treated with surgery alone or surgery combined with radiation therapy, chemotherapy, or with all three treatments, depending on the size of the tumor and the risk of recurrence. Locally advanced breast cancer is usually treated with chemotherapy, radiation therapy, and surgery.

Sometimes combination chemotherapy is used not to cure but to reduce symptoms and prolong life. Combination chemotherapy can be useful for people with advanced cancers that are not suitable for radiation therapy or surgical treatment (for example, people with non–small cell lung cancer, esophageal cancer, or bladder cancer that cannot be completely removed by surgery).

Combination Cancer Therapy
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Cancers of the skin, lungs, colon, stomach, breasts, prostate, and thyroid gland are examples of which type of cancer?

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Kaplan–Meier Curves for Progression-free Survival, According to Treatment Group. Progression-free Survival, According to Subgroups. Kaplan–Meier Curves for Overall Survival, According to Treatment Group.

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N Engl J Med 2012; 367:435-444 DOI: 10.1056/NEJMoa1201622

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Whole books explored and documentedmonogram design, such as An Encyclopedia of Monograms , published in 1884. The book included 5,000 decorative monograms to inspire artists and craftspeople.

Popular women’s magazines of the time, such as Godeys Lady’s Book and Peterson’s Magazine , regularly included alphabets, initials, names and monograms. Middle class readers copied them to embroider nearly every scrap of cloth –tablecloths, sheets, towels, pillowcases and clothing. “Hardly an item in her home escaped from being monogrammed,” writes Rita Weiss, editor of Victorian Alphabets, Monograms and Names . “Young girls learned how to embroider simple alphabets on the linens for her trousseau,” Weiss continues. “By the time she got married, her skills improved and she was ready for more expert work.”

Louis Vuitton company developed its monogram in 1896.

The expert needlework skills attained by women – at all levels of society– and the invention of the Jacquard loom, which spurred faster and cheaper textile manufacturing, coincided to create the perfect circumstances for a boom in monogrammed linens like we’ve never seen before or since, according to Robin Molbert in Monograms and Antique Linens. “Bold and artful monogramming burst into vogue, serving as a kind of democratizing factor in the personalization of one’s linens,” writes Molbert. In England, France and the U.S., women formed sewing and embroidery circles to enjoy and support one another in their endeavors. They shared ideas and perfected their art, incorporating many other aspects including lacework, cut-outs, florals, animal figures and much more.

To this day, many people still cherish, value and collect antique linens from the Victorian Age. A rather funny example: In December 2016, a pair of Queen Victoria’s monogrammed bloomers went on auction, expected to be sold for£6,000. Some famous monograms developed by the Victorians continue to be in vogue. The world of consumer goods offers a perfect example: The interlocking L and V on Louis Vuitton’s bags and luggage. His son Georges designed the iconic image in 1896 to increase sales.

And the practice of monogramming continues to be popular. Whether it’s stationery or wine glasses, ornaments or napkins, personalizing one’s possessions conveys tradition and a sense of pride.

Our story about the monogram isn’t over. Next we ask: what exactly is a monogram?

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, and all Monogrammed Items .

Donna Loftus. “The Rise of the Victorian Middle Class.” BBC History. Website.

Robin Molbert. “The Royal Lineage of Table Linens.” Monograms and Antique Linens. HM Books, 2016.

Another way drones have been able to create value is related to improving processes, so that certain steps or entire processes can be automated or simplified, which is something that can be enabled via full-service subscriptions using images captured from a company’s own drones and smartphones. This is the kind of value that needs to be understood in the context of a roadmap, because it changes the conversation around what can and should be expected from specific pieces of technology like drones.

“One of the reasons I got interested in drones and the discussion that’s happening with them in construction is because I saw they could provide a unique visibility that wasn’t available before,” said Sappington Founder and CEO Tim Goggin. “I also saw people considering them just in terms of being ‘shiny objects’, but that’s what made it a great moment to try and help leaders within construction companies consider technology that enables things like automated inventory across your whole company without lifting a finger. It’s helped them step back and really think about the ways tech can add value to their business.”

Another way to view pile surface and automagically generate inventory reports. Part of the Stockpile Reports analysis.

In the past, having this type of visibility was something that usually only happened on a quarterly or even annual basis, and all of that stems from a conversation around automation. It becomes less about the technology, and more about the new use cases and benefits the technology can provide. Being able to instantly analyze materials in your yard to determine things like their volume and how those piles are moving can create value in countless ways, and that’s without even considering the safety opportunities to measuring them in this manner. Recognizing that goes back to a mind shift that needs to happen when it comes to getting construction professionals to realize that technology is no longer a department.

That said, this kind of adoption can necessitate changes that are about more than bottom-line efficiencies. Thinking differently about technology can have major ramifications when it comes to priorities like safety and environmental concerns, both of which can be difficult to quantify, but essential to consider.

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Technology as a First Class Citizen

Safety has always been a key initiative in construction, and the same goes for environmental issues. Today though, technology also needs to be considered at this level, rather than as merely a part of or complementary to these issues. Doing so stems from the changing in thinking around technology as a department, and instead as one of these essential elements that impacts an entire ecosystem.

Being able to avoid the aforementioned “shiny object syndrome” means being able to think of technology as a first-class citizen, and not as something that can or should be compartmentalized. Organizations that aren’t considering drone technology at this level can end up with solutions that don’t integrate or provide value to the business, at which point they’re left with a lot of technical debt or tools that just get thrown away.

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