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Evolutionary game theory and oligometastatic patient: considering the role of interventional oncology
B Fionda1, R Iezzi, L Tagliaferri
1U.O.C. Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy. bruno.fionda@yahoo.it.
Abstract:
The possible role of evolutionary game theory (EGT), to pursue a tailored therapeutic strategy, has recently gained widespread interest within the clinical setting of oncological patients. The potentially revolutionary shift of paradigm suggested by EGT points to the fact that, for metastatic patients, the optimal therapeutic strategy should be aimed at reducing the survival fitness of tumor cells compared with normal cells, thus allowing natural selection to help control the overall tumor burden, instead of trying to kill all tumor cells. A specific subset of metastatic patients, the so-called oligometastatic patients, has not been adequately considered so far in the light of EGT theoretical approach. A modern and comprehensive definition of oligometastatic patient should consider at least three main parameters: the total number of lesions, the timing of their appearance and their biological heterogeneity. A valid therapeutic option for oligometastatic patients could be to integrate together both systemic and local therapies, such as interventional oncology. The potential advantage of implementing interventional oncology in the clinical practice, for example in oligorecurrent or oligoprogressive patients, could be to delay or even to avoid unnecessary shifts in systemic therapies. Another important point to consider is the potential role that the treatment of a single metastatic site may have in terms of immune system activation towards other untreated metastatic sites; such phenomenon is known as abscopal effect.
Insights
Evolutionary game theory (EGT) offers a new approach for metastatic cancer treatment, focusing on reducing tumor cell fitness to aid natural selection. This strategy is particularly relevant for oligometastatic patients, integrating local and systemic therapies.
Area of Science:
- Oncology
- Evolutionary Biology
- Game Theory
Background:
- Metastatic cancer treatment traditionally aims to eradicate tumor cells.
- Evolutionary game theory (EGT) is emerging as a novel paradigm for cancer therapy.
- Oligometastatic patients represent a specific subset requiring tailored therapeutic strategies.
Purpose of the Study:
- To explore the application of EGT in optimizing therapeutic strategies for metastatic cancer.
- To define oligometastatic patients comprehensively, considering lesion number, timing, and heterogeneity.
- To investigate the integration of systemic and local therapies, including interventional oncology, for oligometastatic patients.
Main Methods:
- Application of evolutionary game theory principles to cancer treatment.
- Defining criteria for oligometastatic patients.
- Evaluating the combined use of systemic therapies and interventional oncology.
- Considering the potential for abscopal effects from localized treatments.
Main Results:
- EGT suggests shifting focus from tumor cell eradication to reducing their survival fitness relative to normal cells.
- A comprehensive definition of oligometastatic patients is proposed, incorporating lesion count, appearance timing, and heterogeneity.
- Integrating interventional oncology with systemic therapies may delay or prevent systemic treatment changes.
- Localized treatment of metastases may activate systemic anti-tumor immunity (abscopal effect).
Conclusions:
- EGT provides a framework for developing personalized therapeutic strategies in oncology.
- Interventional oncology offers a valuable addition to systemic therapy for oligometastatic patients.
- Further research into EGT-guided treatments and abscopal effects could revolutionize metastatic cancer care.
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