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Preventing evolutionary rescue in cancer using two-strike therapy.

Srishti Patil1,2,3, Armaan Ahmed4,5, Yannick Viossat6

  • 1Department of Mathematics, City St George's, University of London, London EC1V 0HB, United Kingdom.

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Switching cancer treatments at the optimal time, when tumors are smallest and undetectable, can maximize eradication probability. This evolutionary strategy suggests treatment timing is crucial for overcoming therapeutic resistance.

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Area of Science:

  • Oncology
  • Mathematical Biology
  • Evolutionary Dynamics

Background:

  • First-line cancer therapies often fail due to emerging therapeutic resistance.
  • Clinical challenge lies in scheduling subsequent treatments for optimal tumor eradication.
  • Understanding tumor vulnerability during minimal size is key.

Purpose of the Study:

  • To provide a theoretical framework for optimizing cancer treatment scheduling.
  • To determine the ideal timing for switching to a second treatment based on evolutionary principles.
  • To explore the impact of tumor parameters and treatment efficacy on eradication success.

Main Methods:

  • Mathematical analysis and extensive stochastic simulations.
  • Application of evolutionary rescue theory.
  • Investigation of tumor extinction probability at different sizes and treatment timings.

Main Results:

  • The optimal time to switch treatment is near the tumor's minimum size (nadir) before relapse.
  • Switching after relapse begins is often preferable to switching too early.
  • Treatment efficacy and tumor evolutionary parameters significantly influence outcomes.
  • A strategy for scheduling drugs with unequal efficacy was determined.

Conclusions:

  • An evolutionarily-informed multi-strike treatment strategy can enhance tumor eradication.
  • Optimal treatment scheduling exploits tumor vulnerability at its smallest, undetectable phase.
  • Findings provide a foundation for experimental and clinical investigation into adaptive cancer therapy.