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- All Subjects: Oncology
- Creators: Maley, Carlo C
Description
Resistance to existing anti-cancer drugs poses a key challenge in the field of medical oncology, in that it results in the tumor not responding to treatment using the same medications to which it responded previously, leading to treatment failure. Adaptive therapy utilizes evolutionary principles of competitive suppression, leveraging competition between drug resistant and drug sensitive cells, to keep the population of drug resistant cells under control, thereby extending time to progression (TTP), relative to standard treatment using maximum tolerated dose (MTD). Development of adaptive therapy protocols is challenging, as it involves many parameters, and the number of parameters increase exponentially for each additional drug. Furthermore, the drugs could have a cytotoxic (killing cells directly), or a cytostatic (inhibiting cell division) mechanism of action, which could affect treatment outcome in important ways. I have implemented hybrid agent-based computational models to investigate adaptive therapy, using either a single drug (cytotoxic or cytostatic), or two drugs (cytotoxic or cytostatic), simulating three different adaptive therapy protocols for treatment using a single drug (dose modulation, intermittent, dose-skipping), and seven different treatment protocols for treatment using two drugs: three dose modulation (DM) protocols (DM Cocktail Tandem, DM Ping-Pong Alternate Every Cycle, DM Ping-Pong on Progression), and four fixed-dose (FD) protocols (FD Cocktail Intermittent, FD Ping-Pong Intermittent, FD Cocktail Dose-Skipping, FD Ping-Pong Dose-Skipping). The results indicate a Goldilocks level of drug exposure to be optimum, with both too little and too much drug having adverse effects. Adaptive therapy works best under conditions of strong cellular competition, such as high fitness costs, high replacement rates, or high turnover. Clonal competition is an important determinant of treatment outcome, and as such treatment using two drugs leads to more favorable outcome than treatment using a single drug. Switching drugs every treatment cycle (ping-pong) protocols work particularly well, as well as cocktail dose modulation, particularly when it is feasible to have a highly sensitive measurement of tumor burden. In general, overtreating seems to have adverse survival outcome, and triggering a treatment vacation, or stopping treatment sooner when the tumor is shrinking seems to work well.
ContributorsSaha, Kaushik (Author) / Maley, Carlo C (Thesis advisor) / Forrest, Stephanie (Committee member) / Anderson, Karen S (Committee member) / Cisneros, Luis H (Committee member) / Arizona State University (Publisher)
Created2023
Description
This review aims to provide a comprehensive review of the most recent literature on adaptive therapy, a promising new approach to cancer treatment that leverages evolutionary theory to prolong tumor control1. By capitalizing on the competition between drug-sensitive and drug-resistant cells, adaptive therapy has led to a paradigm shift in oncology. Through mathematical and in silico models, researchers have examined key factors such as dose timing, cost of resistance, and spatial dynamics in tumor response to adaptive therapy. With a partial focus on preclinical experiments involving ovarian and breast cancer, this review will discuss the demonstrated effectiveness of adaptive therapy in improving progression free survival and tumor control. Through the review process, it was determined that dose modulation outperformed drug-vacation strategies, emphasizing the significance of tumor heterogeneity and spatial structure in accurately modeling adaptive therapy mechanisms. The potential of ongoing clinical trials to improve patient outcomes and long-term treatment efficacy is emphasized, while a thorough analysis of study methodologies shapes the future direction of adaptive therapy research.
ContributorsRichker, Harley (Author) / Maley, Carlo C (Thesis advisor) / Compton, Carolyn (Committee member) / Wilson, Melisaa (Committee member) / Arizona State University (Publisher)
Created2023
Description
Cancer is a major health problem in the world today and is expected to become an even larger one in the future. Although cancer therapy has improved for many cancers in the last several decades, there is much room for further improvement. Mathematical modeling has the advantage of being able to test many theoretical therapies without having to perform clinical trials and experiments. Mathematical oncology will continue to be an important tool in the future regarding cancer therapies and management.
This dissertation is structured as a growing tumor. Chapters 2 and 3 consider spheroid models. These models are adept at describing 'early-time' tumors, before the tumor needs to co-opt blood vessels to continue sustained growth. I consider two partial differential equation (PDE) models for spheroid growth of glioblastoma. I compare these models to in vitro experimental data for glioblastoma tumor cell lines and other proposed models. Further, I investigate the conditions under which traveling wave solutions exist and confirm numerically.
As a tumor grows, it can no longer be approximated by a spheroid, and it becomes necessary to use in vivo data and more sophisticated modeling to model the growth and diffusion. In Chapter 4, I explore experimental data and computational models for describing growth and diffusion of glioblastoma in murine brains. I discuss not only how the data was obtained, but how the 3D brain geometry is created from Magnetic Resonance (MR) images. A 3D finite-difference code is used to model tumor growth using a basic reaction-diffusion equation. I formulate and test hypotheses as to why there are large differences between the final tumor sizes between the mice.
Once a tumor has reached a detectable size, it is diagnosed, and treatment begins. Chapter 5 considers modeling the treatment of prostate cancer. I consider a joint model with hormonal therapy as well as immunotherapy. I consider a timing study to determine whether changing the vaccine timing has any effect on the outcome of the patient. In addition, I perform basic analysis on the six-dimensional ordinary differential equation (ODE). I also consider the limiting case, and perform a full global analysis.
This dissertation is structured as a growing tumor. Chapters 2 and 3 consider spheroid models. These models are adept at describing 'early-time' tumors, before the tumor needs to co-opt blood vessels to continue sustained growth. I consider two partial differential equation (PDE) models for spheroid growth of glioblastoma. I compare these models to in vitro experimental data for glioblastoma tumor cell lines and other proposed models. Further, I investigate the conditions under which traveling wave solutions exist and confirm numerically.
As a tumor grows, it can no longer be approximated by a spheroid, and it becomes necessary to use in vivo data and more sophisticated modeling to model the growth and diffusion. In Chapter 4, I explore experimental data and computational models for describing growth and diffusion of glioblastoma in murine brains. I discuss not only how the data was obtained, but how the 3D brain geometry is created from Magnetic Resonance (MR) images. A 3D finite-difference code is used to model tumor growth using a basic reaction-diffusion equation. I formulate and test hypotheses as to why there are large differences between the final tumor sizes between the mice.
Once a tumor has reached a detectable size, it is diagnosed, and treatment begins. Chapter 5 considers modeling the treatment of prostate cancer. I consider a joint model with hormonal therapy as well as immunotherapy. I consider a timing study to determine whether changing the vaccine timing has any effect on the outcome of the patient. In addition, I perform basic analysis on the six-dimensional ordinary differential equation (ODE). I also consider the limiting case, and perform a full global analysis.
ContributorsRutter, Erica Marie (Author) / Kuang, Yang (Thesis advisor) / Kostelich, Eric J (Thesis advisor) / Frakes, David (Committee member) / Gardner, Carl (Committee member) / Jackiewicz, Zdzislaw (Committee member) / Arizona State University (Publisher)
Created2016