Clonal Diversity at Early Cancer Recurrence

Despite initial success, cancer therapies often fail due to the emergence of drug-resistant cells. In this study, we use a mathematical model to investigate how cancer evolves over time, specifically focusing on the state of the tumor when it recurs after treatment. We use a two-type birth-death process to capture the dynamics of both drug-sensitive and drug-resistant cells. Assuming resistant cells have equal fitness, we analyze the clonal diversity of drug-resistant cells at the time of cancer recurrence, which is defined as the first time the population size of drug-resistant cells exceeds a specified proportion of the initial population size of drug-sensitive cells. We examine two clonal diversity indices: the number of clones and the Simpson's Index. We calculate the expected values of these indices at the time of cancer recurrence. Additionally, we examine these two indices conditioned on early recurrence in the special case of a deterministically decaying sensitive population, with the aim of addressing the question of whether early recurrence is driven by a single mutation that generates an unusually large family of drug-resistant cells (corresponding to a low clonal diversity), or if it is due to the presence of an unusually large number of mutations causing drug resistance (corresponding to a high clonal diversity). Our findings, based on both indices, support the latter possibility. Furthermore, we demonstrate that the time of cancer recurrence can serve as a valuable indicator of clonal diversity, providing new insights into the evolutionary dynamics of recurrent cancers.