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Workshop 2 Abstracts and Lecture Materials:
Author: Zvia Agur, Institute
for Medical Biomathematics
Title: Inter-Dosing Interval Can Determine Efficacy/toxicity Tradeoff
in Cytotoxic and
Supportive Cancer Therapy: Prospective Validation of a Mathematical
Theory
Streaming Video: Real
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The phenomenon of resonance in population dynamics - enhancement
of population growth when the period of the imposed loss process
coincides with the inherent periodicity of the population has been
applied in many areas of disease control, including African Trypanosomiasis,
measles and cancer. The latter application for improving efficacy
of chemotherapy, denoted the "Z-Method," has been validated experimentally
in mice, suggesting that it is feasible to control cancer load as
well as host toxicity by rational drug scheduling.
The above concept was further investigated in a comprehensive effort
to put forward clinically validated improved cancer treatments.
Thus, sets of detailed computerized mathematical models of the full
process of tumor progression and of haematopoiesis have been constructed
and thoroughly investigated. One of the conclusions is that reducing
the dosing interval of standard chemotherapy will increase the efficacy
of non-Hodgkin's lymphomas (NHL) treatment.
Thrombocytopenia was shown to be significantly associated with
NHL chemotherapy. Thrombopoietin (TPO), has been developed as a
therapeutic agent to attenuate thrombocytopenia, but its immunogenicity
is a serious impediment to further pharmaceutical development. To
overcome this problem a computer-implemented mathematical model
for thrombopoiesis has been employed, predicting that platelet counts,
similar to those obtained with accepted TPO dose scheduling, can
also be achieved by new schedules, having significantly reduced
immunogenicity and improved efficacy. These predictions have been
prospectively validated in pre-clinical trials, thus substantiating
the benefit of further TPO development.
Author: Alexander R.A. Anderson, University of Dundee
Title: Modelling Solid Tumour Invasion: The Importance of Adhesion
Streaming Video: Real
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The development of a primary solid tumour (e.g., a carcinoma) begins
with a single normal cell becoming transformed as a result of mutations
in certain key genes (e.g., P53), this leads to uncontrolled proliferation.
An individual tumour cell has the potential, over successive divisions,
to develop into a cluster (or nodule) of tumour cells consisting
of approximately 106 cells. This avascular tumour cannot
grow any further, owing to its dependence on diffusion as the only
means of receiving nutrients and removing waste products. For any
further development to occur the tumour must initiate angiogenesis
- the recruitment of blood vessels. After the tumour has become
vascularised via the angiogenic network of vessels, it now has the
potential to grow further and invade the surrounding tissue. There
is now also the possibility of tumour cells finding their way into
the circulation and being deposited in distant sites in the body,
resulting in metastasis.
In this talk we present a hybrid discrete/continuum mathematical
model, which describes the invasion of host tissue by tumour cells
and examines how changes in key cell attributes (e.g. P53 mutation,
cell-cell adhesion, invasiveness) affect the tumour's growth. In
the model, we focus on four key variables implicated in the invasion
process, namely, tumour cells, host tissue (extracellular matrix,
ECM), and matrix-degrative enzymes (MDE) associated with the tumour
cells and oxygen supplied by the angiogenic network. The continuous
mathematical model consists of a system of partial differential
equations describing the production and/or activation of degradative
enzymes by the tumour cells, the degradation of the matrix, oxygen
consumption, and the migratory response of the tumour cells. The
hybrid model focuses on the micro-scale (individual cell) level
and uses a discrete technique developed in previous models of angiogenesis.
This technique enables one to model migration and invasion at the
level of discrete cells whilst still allowing the chemicals (e.g.,
MDE, ECM, oxygen) to remain continuous. Hence it is possible to
include micro-scale processes both at the cellular level (such as,
proliferation, cell-cell adhesion) and at the sub-cellular level
(such as, cell mutation properties). This in turn allows us to examine
the effects of such micro-scale changes upon the overall tumour
geometry and subsequently the potential for metastatic spread.
Author: Jessie Au, College of Pharmacy, The Ohio State University
Streaming Video: Real
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Author: Nicola Bellomo,
Department of Mathematics, Politecnico of Torino
Title: Multiscale Modelling of Cellular Systems in the Competition
between Tumor and Immune System.
Abstract: PDF
Presentation Materials: PDF
Streaming Video: Real
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Author: Mark A.J. Chaplain, The SIMBIOS Centre, Division of Mathematics,
University of Dundee
Title: Mathematical Modelling of the Spatio-Temporal Response of
Cytotoxic T-lymphocytes to a Solid Tumour
Streaming Video: Real
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In this talk we will present a mathematical model describing the
growth of a solid tumour in the presence of an immune system response.
In particular, attention is focussed upon the interaction of tumour
cells with so-called tumour-infiltrating cytotoxic lymphocytes (TICLs),
in a small, multicellular tumour, without central necrosis and at
some stage prior to (tumour-induced) angiogenesis. At this stage
the immune cells and the tumour cells are considered to be in a
state of dynamic equilibrium (cancer dormancy). The lymphocytes
are assumed to migrate into the growing solid tumour and interact
with the tumour cells in such a way that lymphocyte-tumour cell
complexes are formed. These complexes result in either the death
of the tumour cells (the normal situation) or the inactivation (sometimes
even the death) of the lymphocytes. The migration of the TICLs is
determined by a combination of random motility and chemotaxis in
response to the presence of specialized interleukins (chemokines).
The resulting system of four nonlinear partial differential equations
(TICLs, tumour cells, complexes and chemokines) is analysed and
numerical simulations are presented. The numerical simulations demonstrate
the existence of cell distributions that are quasi-stationary in
time but unstable and heterogeneous in space. A linear stability
analysis of the underlying (spatially homogeneous) ODE kinetics
coupled with a numerical investigation of the ODE system reveals
the existence of a stable limit cycle. This is verified further
when a subsequent bifurcation analysis is undertaken using a numerical
continuation package. These results then explain the complex heterogeneous
spatio-temporal dynamics observed in the PDE system.
Author: Li Deng, Rice
University
Title: Modeling the Cell Proliferation, Carcinogenesis in Lung Cancer:
Taking the Interaction Between Genetic Factors and Smoking into
Account
Presentation Materials: PPT
Streaming Video: Real
Media
A stochastic two-stage carcinogenesis model has been widely used
to model the mechanism of tumor development for varieties of cancers
and some interesting results have been revealed by this approach.
In our research, we are focusing on studies of several risk factors'
influence on initiation and promotion of lung cancer by applying
such a model. We modify a traditional two-stage (MVK) model and
integrate the environmental exposure, namely cigarette smoking and
genetic information into both mutation stages and the cell proliferation
rate of intermediate cells. Some experiment data, which measure
the cigarette metabolism capacity and DNA repair capacity, enable
us to explore the risk of individual's genetic susceptibility in
the development of lung cancer. Through the estimates of some important
biological parameters, we can make inference on the impact of the
several risk factors and their interaction in the carcinogenesis
of lung cancer.
Author: Edison Liu, Genome Institute of Singapore
Title: Expression Genomics and the Cellular Pharmacology of Cancer
Therapeutics
Author: Alberto Gandolfi, Istituto di Analisi dei Sistemi ed Informatica;
Alessandro Bertuzzi, Istituto di Analisi dei Sistemi ed Informatica
- CNR; Antonio Fasano, Department of Mathematics, University of
Florence
Title: Modelling the Regression and Regrowth of Tumour Cords Following
Cell Killing
Presentation Materials: PDF
Streaming Video: Real
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In some human and experimental tumours, cylindrical arrangements
of tumour cells growing around central blood vessels and generally
surrounded by necrosis have been observed [1]. These structures
were called tumour cords. Oxygen and nutrient deprivation are considered
to be the main factors in determining the occurrence of necrosis
at the cord periphery. In [2], a mathematical model has been developed
that describes in cylindrical symmetry and according to the continuum
approach the behaviour of a cord under the influence of a cell killing
treatment. The diffusion of a chemical critical for cell viability,
assumed to be the oxygen, is taken into account. Cells proliferate
at a rate depending on the oxygen concentration and become quiescent
below a threshold value of this concentration. Massive cell death
occurs when the concentration reaches another threshold at a lower
value, marking the cord boundary. The model also accounts for both
spontaneous and treatment induced cell death within the cord. The
necrotic material produced by cell death is removed according to
a first order kinetics. Under the assumption that the volume fraction
occupied by cells and necrotic material is constant within the cord,
the velocity field that describes cell motion is obtained. To describe
the effect of chemotherapy, the model has been coupled to a single
equation describing drug diffusion from the vessels. The response
to different single-dose treatments (radiation or drugs), starting
from the stationary state of the cord, has been simulated [3]. The
model evidences the existence of a transient phase of reoxygenation
after treatment, due to cell death and cord shrinkage. Thus, a time
window exists in which the surviving cells should exhibit an increased
sensitivity to a successive dose of the therapeutic agent.
[1] Tannock, I.F. (1968). The relation between cell proliferation
and the vascular system in a transplanted mouse mammary tumour.
Br. J. Cancer, 22, 258-273.
[2] Bertuzzi, A., Fasano, A., & Gandolfi, A. A free boundary
problem with unilateral constraints describing the evolution of
a tumour cord under the influence of cell killing agents. Manuscript
submitted for publication.
[3] Bertuzzi, A., d'Onofrio, A., Fasano, A., & Gandolfi, A.
(2003). Regression and regrowth of tumour cords following single-dose
anticancer treatment. Bull. Math. Biol., 65, 903-931.
Author: Leonid Hanin, Idaho State
University/ University of Rochester
Title: Distibution of the Number of Clonogenic Tumor Cells Surviving
Fractionated Radiation.
Streaming Video: Real
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We solve, under realistic biological assumptions, the following
long-standing problem: To find the distribution of the number, N,
of clonogenic tumor cells surviving a given arbitrary schedule of
fractionated radiation. We show that the distribution of the number
N at any time t after treatment belongs to the class of generalized
negative binomial distributions, find an explicit computationally
feasible formula for the distribution in question, and identify
its limiting forms. In particular, for t = 0 the limiting distribution
turns out to be Poisson, and an estimate of the rate of convergence
in the total variation metric similar to the classical Law of Rare
Events is obtained.
Author: Ollivier
Hyrien, University of Rochester Medical Center
Title: Analysis of the Effect of an Anti-Cancer Drug on Cell Proliferation.
In this talk, we propose a method to analyze the effect of an anti-cancer
drug on the proliferation of oligodendrocytes and O-2A progenitor
cells in culture conditions. The dynamic of the cell population
is represented by a multitype Bellman-Harris branching process,
which describes the division and differentiation processes as well
as the potential action of the drug. A statistical method is also
described for quantitative inference from clonal data and the proposed
methodologies are illustrated on a real data set.
Author: Steven E. Kern, Department of Pharmaceutics and Department
of Anesthesiology, University of Utah
Title: Modeling Multiple-Drug Interactions with Response Surfaces
Streaming Video: Real
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Drug delivery strategies that maximize positive effects and minimize
side effects often employ drug combinations. For cancer chemotherapy,
this approach represents the standard of care. There are two primary
methods for characterizing pharmacodynamic interactions: isoboles
and response surfaces. Isoboles model interactions at a specific
level of drug effect. Response surfaces characterize the interaction
over a range of effects and are therefore more generally applicable
for understanding interactions. Past approaches for modeling response
surfaces have presented many problems that limit their generalizability.
These include: inability to converge to simple models under constrained
conditions, the creation of illogical surfaces, particularly for
antagonistic reaction, lack of meaningful parameters that can be
compared between different combinations, and the inability to model
assymetric interactions surfaces. We have developed a new method
for modeling response surfaces of drug interactions that overcome
limitations of previous models.
Our proposed model is based on a Hill concentration-response profile
that considers each drug combination as a virtual drug acting in
a sigmoid manner. The model use polar coordinates to fit synergistic,
additive, and antagonistic interactions as defined by Loewe.[1]
We have used simulated data sets to assess the ability of the model
to fit a number of different types of drug interactions and have
compared these results to other response surface models that have
been proposed in the literature. The model was also applied to clinical
data for the interaction of the opioid alfentanil with the induction
agent propofol that was previously reported by Short et al and also
modeled by Minto et al. using response surfaces.[2,3] Aikike Information
Criteria (AIC) was used to compare the models.
The proposed model has greater flexibility in terms of adequately
fitting a number of different interaction conditions from the simulated
data. This included asymmetric interactions, competitive antagonistic
interactions, and inverse agonist interactions. The model interaction
parameter can be statistically assessed to evaluate the significance
of the interaction. The proposed model also fit the clinical data
well with a comparable AIC to that reported by Minto et al. Further
application to antiproliferative agents and leukemia treatments
are under way. The flexibility and adequacy of this new model will
enhance its application to characterizing the nature and extent
of interaction of co-administered drugs.
References:
1. Loewe, S. (1953). The problem of synergism and antagonism of
combined drugs. Arzneim. Forsch, 3, 2.
2. Short, T.G., Plummer, J.L., Chui, P.T. (1992). Hypnotic and
anaesthetic interactions between midazolam, propofol and alfentanil.
Br J Anaesth, 69, 162-7.
3. Minto, C. F., Schnider, T. W., Short, T. G., Gregg, K. M., Gentilini,
A., & Shafer, S. L. (2000). Response surfaces for anesthetic
drug interactions. Anesthesiology, 92,1603-1616.
Author: Marek Kimmel, Department
of Statistics, Rice University
Title: Modeling Progression of Lung Cancer: From Genetic Susceptibility
to Tumor Growth and Metastasis
Presentation Materials: PPS1
Streaming Video: Real
Media
The talk is an overview of results by the presenter and his colleagues,
concerning probabilistic and statistical modeling of lung cancer.
The underlying processes studied are (1) carcinogenesis as a random
process being function of genetic susceptibility and behavioral
factors, (2) tumor growth, with emphasis on stochasticity and ascertainment
phenomena, and (3) cancer spread through metastasis. Methodology
includes stochastic processes, estimation theory and Monte Carlo
simulations. The interplay between underlying biology and medical
observations (detection) is discussed. The models presented, beside
mathematical and scientific interest, have health policy implications.
Author: Jan Lankelma, Department of Medical Oncology, VU medical
center
Title: Transport of Small-Molecule Drugs, from Injection Site to
the Target
Streaming Video: Real
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After injection into the blood drugs will be cleared from the body,
and transported into tissues and sometimes metabolized. As a result
after an intravenous bolus injection the blood concentration will
decrease and this decrease can be described by pharmacokinetic models,
which can be linear or nonlinear models. At the time scales mostly
met in these models the blood concentration can be regarded as homogeneous
(stirred tank model). Presently, in cancer chemotherapy mostly small-molecule
drugs (mol. wt < 1000 Da) are being used. When compared to large
molecules, such as proteins, small-molecule drugs diffuse relatively
fast. However, in some cases, e.g. when tissue components have a
high binding capacity, the effective diffusion from the capillary
blood vessels can be slow for small molecules, as well. In the tissue
the observed drug concentrations can then be different from cell
to cell. This was demonstrated for the fluorescent drug doxorubicin
in islets of human breast cancer, where concentration gradients
were found at 2-24 h after i.v. injection, with the highest concentrations
at the rim of the islet (Lankelma et al. 1999).
A mathematical model was developed describing doxorubicin transport
by diffusion from the smallest blood capillaries into the tumor
tissue (Lankelma et al. 2000). Using transport parameters measured
in vitro for doxorubicin, the model could explain the observed gradients.
The model showed that the radius of the islet and the width of the
interstitium between the cells could have a significant influence
on the steepness of the gradient. We could also calculate the drug
tissue concentration-versus-time profiles at different distances
from the rim of the islets, using the blood concentration-versus-time
profile as a boundary condition.
The profiles after an i.v. injection were mimicked in vitro using
MCF-7 breast cancer cells. Extrapolating to the in vivo situation,
the model predicted less drug-induced cell damage at the rim when
compared to the center of the islets (Lankelma, 2003) .
Other drugs may also show concentration gradients in tumor tissue
(Lankelma, 2002). In the absence of autofluorescence, the presence
of gradients can be detected by autoradiography (ex vivo) or potentially
by immunohistochemistry of proteins that will be induced by the
drug in a concentration dependent way.
References:
Lankelma, J., Dekker, H., Luque, F. R., Luykx, S., Hoekman, K.,
van der Valk, P., et al. (1999). Doxorubicin gradients in human
breast cancer. Clin Cancer Res, 5, 1703-7.
Lankelma, J., Fernandez Luque, R., Dekker, H., & Pinedo, H.
M. (2003). Simulation model of doxorubicin activity in islets of
human breast cancer cells. Biochim Biophys Acta, 1622, 169-78.
Lankelma, J., Fernandez Luque, R., Dekker, H., Schinkel, W., &
Pinedo, H. M.. (2000). A mathematical model of drug transport in
human breast cancer. Microvasc Res, 59, 149-61.
Lankelma, J. (2002). Tissue transport of anti-cancer drugs. Curr
Pharm Des, 8, 1987-1993.
Authors: Urszula Ledzewicz, Department of Mathematics and Statistics,
Southern Illinois University; and Heinz Schaettler, Department of
Electrical and Systems Engineering Washington University
Title: Mathematical Methods for the Analysis of Optimal Controls
in Compartmental Models for Cancer Chemotherapy
Abstract: PDF
Author: Gary K. Schwartz,
Memorial Sloan-Kettering Cancer Center
Title: Development of Cell Cycle Inhibitors in Combination with
Chemotherapy for the Treatment of Human Malignancies
Streaming Video: Real
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Despite recent advances in the treatment of some types of metastatic
solid tumors, patients still do poorly and cures are quite rare.
The ultimate cure of cancer will depend on finding novel ways to
kill cancer cells. Cell death proceeds through a process called
apoptosis. Apoptosis is tightly regulated by a series of parallel
signal transduction pathways: one leading to cellular survival and
the other to cell death. The failure of current chemotherapy, in
fact, represents the inability to activate those signaling events
that direct the tumor cell to its own demise, and/or the inability
to interrupt the signaling events that promote tumor cell survival.
Therefore, the future of cancer therapy depends on tipping the balance
of these tightly regulated reciprocal pathways away from tumor cell
survival to cell death.
One approach that appears especially promising is to combine chemotherapy
with small targeted molecules that enhance chemotherapy-induced
apoptosis and result in an increased anti-tumour effect. Two promising
candidate drugs include flavopiridol, a synthetic flavone, and UCN-01,
7-OH-staurosporine. They have been identified in the NCI drug screen
as potent inhibitors of the cyclin dependent kinases (CDK's) and
induce cell cycle arrest. Clinically, though, there has been little
evidence of single agent activity. However, both drugs potently
enhance the induction of apoptosis by a wide range of chemotherapeutic
agent. These include irinotecan (CPT-11), gemcitabine, cisplatin
and docetaxel, as well as radiation. The effects of these combinations
are best achieved with sequential therapy, such that the chemotherapy
(or radiation) must come before the flavopiridol or the UCN-01.
For example, Hct116 colon cancer cells can be sensitized to undergo
apoptosis in vitro by adding nanomolar concentrations of flavopiridol
AFTER treatment with SN-38 (the active metabolite of CPT-11). Similarly,
in vivo, single agent CPT-11 induced some tumor regressions but
no complete responses (CR) in the Hct116 xenografts. However, CPT-11
followed by flavopiridol resulted in over a doubling of tumor regressions
and a 30% CR rate.
These preclinical studies have been translated into phase I clinical
trials of sequential combination therapy. These combinations have
proven generally well tolerated and micromolar concentrations of
these agents can be achieved. We have seen promising antitumor activity.
Thus, this class of drug may provide a completely new therapeutic
strategy in the treatment of patients with advanced cancers. (Supported
by NCI R01-CA67819)
Author: Jaroslaw Smieja
and Andrzej Swierniak, Silesian University of Technology, Department
of Automatic Control, Gliwice, Poland
Title: Models of Cancer Population Evolution Combining Multi-Drug
Chemotherapy and Drug Resistance.
Presentation Materials: PPT
A factor that can have a strong influence on the evolution of drug
resistance of cancer cells is gene amplification. This process includes
an increase in the number of copies of a gene coding for a protein
that supports either removal or metabolization of the drug. The
more copies of the gene present, the more resistant the cell, in
the sense that it can survive under higher concentrations of the
drug. Increase of drug resistance by gene amplification has been
observed in numerous experiments with in vivo and cultured cell
populations. In addition it has been established that, at least
in some experimental systems, tumor cells may increase the number
of copies of an oncogene in response to unfavorable environment.
Mathematical modeling of gene amplification has provided good fits
to experimental data. These results suggest that drug resistance
and other processes altering the behavior of cancer cells may be
better described by multistage mechanisms, including a gradual increase
in number of discrete units. The multistage stepwise model of gene
amplification or, more generally, of transformations of cancer cells,
leads to new mathematical problems and results in novel dynamic
properties of the systems involved. The mathematical modeling results
suggest that under gene amplification dynamics with high amplification
probability, protocols involving frequent low-concentration dosing
may result in the rapid evolution of large fully resistant residual
tumors; the same total doses divided into high-concentration doses
applied at larger intervals may result in partial or complete remission.
Most of existing forms of therapy consist in using several drugs,
instead of a single one, since such chemotherapy might reduce drug
resistance effects. Then, modelling should take into account increasing
drug resistance to each of the used chemotherapeutic agents. Moreover,
each drug affects cell being in particular cell phase and it makes
sense to combine these drugs so that their cumulative effect on
the cancer population would be the greatest. So far, phase-specific
chemotherapy has been considered only in the finite-dimensional
case, without any regard to problems stemming from increasing drug
resistance The talk will deal with models that take into account
both the phenomenon of gene amplification and multidrug chemotherapy,
in their different aspects, so far been studied separately. Combining
infinite dimensional model of drug resistance with the multidrug
and/or phase-specific model of chemotherapy should move mathematical
modelling much closer to its clinical application. Different examples
will be discussed, each of them addressing different aspects of
cancer cell modelling. As the first one, a model taking into account
partial sensitivity of the resistant subpopulation will be introduced.
In this case, it is assumed that the resistant subpopulation consists
of two parts - one, which is sensitive to the drug (but, contrary
to previous works, may contain cells of different drug sensitivity),
and another one, completely drug-resistant. Subsequently, an attempt
to model multidrug (but not phase-specific) protocols will be presented
that take into account increasing drug resistance to each used chemotherapeutic
agent used. Finally, different cases of phase-specific control of
the drug-sensitive cancer population will be addressed.
Author: Cynthia Sung, Human Genome Sciences, Director, Clinical
& Preclinical Pharmacology
Title: Interspecies Allometric Modeling of the Pharmacokinetics,
Biodistribution and Dosimetry of LymphoRad-131, a Radiolabeled Cytokine
Targeted to B Cells
Presentation Materials: http://jnm.snmjournals.org/cgi/content/abstract/44/3/422
LymphoRad-131 (LR131) is iodine-131 labeled BLyS protein, a cytokine
that binds to B lineage cells, but not T cells, monocytes, natural
killer cells or granulocytes. This unique binding profile suggests
that LR131 may be a useful treatment for B cell neoplasias such
as B cell lymphomas and multiple myeloma. The pharmacokinetics and
biodistribution of iodine-125 BLyS after intravenous injection into
normal and tumor-bearing mice will be described. These data were
used to predict radiation dosimetry in human subjects by means of
interspecies allometric modeling and MIRDose, a program for internal
dose assessment in nuclear medicine. Clinical trials of LR-131 are
currently being conducted in patients with multiple myeloma and
non-Hodgkin's lymphoma. Whole body gamma scintigraphy is performed
on each paitent in order to obtain radiation dosimetry estimates
for major organs and tumors. Results from the first cohort of patients
will be compared to those predict ed from allometric modeling.
Author: Andrzej Swierniak,
Silesian University of Technology
Title: Phase Specificity and Drug Resistance in Optimal Protocols
Design for Cancer Chemotherapy
Presentation Materials: PPT
Streaming Video: Real
Media
Mathematical modeling of cancer chemotherapy has hadmore than four
decades of history. It has contributed to the development of ideas
of chemotherapy scheduling, multidrug protocols, and recruitment.
It has also helped in the refinement of mathematical tools of control
theory applied to the dynamics of cell populations[10]. However,
regarding practical results it has been, with minor exceptions,
a failure. The reasons for that failure are not always clearly perceived.
They stem from the direction of both biomedicine and mathematics:
important biological processes are ignored and crucial parameters
are not known, but also the mathematical intricacy of the models
is not appreciated. In this talk, we would like to outline several
directions of research which may play a role in improving the situation
and realizing the obvious potential existing in the mathematical
approach. We are concerned with three issues:
1. The inner structure of the cell cycle and the cell-cycle-phase
specificity of some chemotherapy agents.
2. The dynamics of emergence of resistance of cancer cells to chemotherapy,
as understood based on recent progress in molecular biology.
3. Estimation of quantitative parameters of the cell cycle, drug
action and cell mutation to resistance.
The main purpose of the talk is to outline our own views on the
issues involved. The talk will be in large part a critical survey
of published work by us and others. It also includes material not
published before. Wherever appropriate, we give credit to others,
without attempts at an exhaustive review.
The philosophy of this talk is related to our professional experience.
The first author has been involved for a decade in attempts to develop
a satisfactory theory of optimal control of bilinear systems resulting
from a description of chemotherapy action using ordinary differential
equations. The second author has spent a similar period in a cancer
research institute trying to develop models of the cell cycle for
the purpose of estimation of cell-cycle-phase specificaction of
anticancer drugs. More recently, he has investigated gene amplification
as the mechanism of resistance of cancer cells.The last two authors
have been engaged in mathematical projects on higher order conditions
of optimality and recently have used their results to clarify the
status of the candidates for optimal protocols worked out by the
first two authors.
The cell-cycle-phase specificity is essential for the initial period
of chemotherapy, when at issue is the most efficient reduction of
the cancer burden. This seems to be of practical importance in nonsurgical
cancers such as for example leukemias. Emergence of clones of cancer
cells resistant to chemotherapy is important in treatment and prevention
of systemic spread of disease. This comprises potential treatment
of metastasis and all variants of adjuvant chemotherapy.
Cell-cycle-phase specificity of some cytotoxic drugs is important
since itmakes sense to apply anticancer drugs when cells gather
in the sensitive phases of the cell cycle. It can be approached
by considering dissection of the cell cycle into an increasing number
of disjoint compartments, with drug action limited to only some
of them. We provide a classification of several simplest models
of this kind. Mathematical problems encountered include singularity
and non-uniqueness of solutions of the optimization problems. There
exist also conceptual problems. One of them is that of the "resonances",
postulated by many authors (eg.Dibrov[2], Agur[1]) as the way to
either maximize the efficacy of treatment or to spare the organism's
normal cells.
The emergence of resistance to chemotherapy has been first considered
in a point mutation model of Coldman and Goldie[4] and then in the
framework of gene amplification by Agur and Harnevo[5]. The main
idea is that there exist spontaneous or induced mutations of cancer
cells towards drug resistance and that the scheduling of treatment
should anticipate these mutations. The point mutation model can
be translated into simple recommendations, which have even been
recently tested in clinical trials. The gene amplification model[6]
was extensively simulated and also resulted in recommendations for
optimized therapy. We present a model of chemotherapy based on a
stochastic approach to evolution of cancer cells[7]. Asymptotic
analysis of this model results in some understanding of its dynamics[11].
This, in our opinion, is the first step towards a more rigorous
mathematical treatment of the dynamics of drug resistance and/or
metastasis[12].
The simplest cell-cycle-phase dependent models of chemotherapy
can be classified based on the number of compartments and types
of drug action modeled[14]. 2 In all these models the attempts at
finding optimal controls are confounded by the presence of singular
and periodic trajectories, and multiple solutions[13],[15] . However,
efficient numerical methods have been developed[3]. Moreover recently
singularity of optimal arcs was excluded for a broad class of the
models and sufficient conditions for optimal bang-bang strategies
were found[8],[9]. In simpler cases, it is possible to provide exhaustive
classification of solutions. We have reviewed analytic and computational
methods which are available. The traditional area of application
of ideas of cell synchronization, recruitment and rational scheduling
of chemotherapy including multidrug protocols, is in treatment of
leukemias[14]. It is there where the cell-cycle-phase dependent
optimization is potentially useful.
Concerning the emergence of drug resistance, we have presented
the problem in the framework of gene amplification, although much
of what is written may apply to different mechanisms which are reversible
and occur at high frequency. We have defined a mathematical model
which can be used to pose and solve an optimal chemotherapy problem
under evolving resistance. We have shown preliminary results regarding
dynamics of this model. Analysis of variants of this model should
give insight into possible scheduling strategies of chemotherapy
in the situations when drug resistance is a significant factor.
All possible applications of the mathematical models of chemotherapy
are contingent on our ability to estimate their parameters. There
has been a progress in that direction, particularly concerning precise
estimation of drug action in culture and estimation of cell cycle
parameters of tumor cells in vivo. Also, more is known about the
mutation rates of evolving resistant cell clones. The emergence
of resistant clones is a universal problem of chemotherapy. However,
it seems that its most acute manifestation is the failure to treat
metastasis. A part of this problem is the imperfect effectiveness
of adjuvant chemotherapy as the tool to eradicate undetectable micrometastases.
In view of toxicity of anticancer drugs, optimal scheduling is potentially
useful in improving these treatments.
This research was supported by NSF and Polish Academy of Science
in the form of addendum to NSF grant DMS 0205093 for three authors(AS,
UL, HS) and by the internal grant BK275/RAu1/03 of SUT for two authors(AS,
MK).
References
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Author: Paolo Ubezio,
Department of Oncology Istituto di Ricerche Farmacologiche "Mario
Negri"
Title: Kinetics of Cell Cycle Response of Cancer Cells to Drug Treatment
Presentation Materials: PPT
Streaming Video: Real
Media
Cells respond to a drug challenge by activating programs of cell
cycle arrest or suicide (apoptosis). The knowledge of the kinetics
of such events in applied research can support the design of rationales
of drug scheduling or drug combinations. In basic research it can
contribute to the knowledge of the mechanisms of drug-induced cell
death and of the drug interactions with cell cycle checkpoints.
However, no substantial progress has been made on how to describe
these effects in quantitative terms. The problem is complicated
by the fact that the response to treatment is heterogeneous even
in populations of genetically identical cells, like a cell line
growing in vitro. Only a fraction of cells (not all) is blocked,
some cells repair DNA damage and recycle, some others are killed.
Then, the values of these fractions depend on the treatment dose.
In order to tackle the complexity of such situation we explored
a mixed experimental-theoretical approach. We used an ovarian carcinoma
cell line (IGROV-1) growing in vitro and we made measures at different
drug concentrations and times with different techniques (particularly
by flow cytometry), with a particular experimental design. Then
a mathematical model of cellular proliferation kinetics was used
to reconstruct the cell flows into the different phases of the cell
cycle (G1, S and G2M) after a treatment. The inputs are parameters
("effect descriptors") directly describing the biological effects
induced by the treatment, i.e. cell cycle arrest, DNA repair and
cell death in G1, S and G2M, in probabilistic terms. The output
is a set of values that are equivalent to the measured data, like
absolute number of cells or flow cytometric phase percentages, and
can be directly compared with them. The aim of the analysis is to
find a set (or the sets) of descriptors coherent with the data,
i.e. producing simulated measures in the range of precision of the
real measures. In case of the coexistence of more-than-one scenarios
consistent with the data, the discrimination between them is performed
experimentally (not mathematically, e.g. with best fit procedures),
by additional experiments suggested by the simulation itself. At
the end of the procedure, only a single set of parameter values
will give the scenario coherent with all experimental measures.
This methodology has been successfully applied in studies on classical
and new anticancer drugs.
Author: John Weinstein, Genomics & Bioinformatics Group, Laboratory
of Molecular Pharmacology, Center for Cancer Research, National
Cancer Institute
Title: Genomics and Bioinformatics in Cancer Drug Discovery: A Tale
of Two Scientific Cultures
The first challenge after a microarray or other 'omic' (1,2) experiment
is to analyze the data statistically. The second is to interpret
the resulting lists of genes biologically. The third is to integrate
the data with other types of molecular and pharmacological information
('IntegromicsTM'). We have developed a number of practical software
tools for meeting those three challenges: MedMiner (3), which speeds
up 5-10 fold the organization of biomedical literature on genes
and drugs; CIMminer (4,5), which flexibly produces Clustered Image
Maps ('heat maps'); MatchMiner (6), which translates fluently among
the many types of gene and protein identifiers; GoMiner (7), which
leverages the Gene Ontology for discovery of functional order in
lists of genes; MethMiner, which organizes patterns of sequence
information from DNA methylation studies; LeadScope/ LeadMiner (8),
which links genomic and proteomic information to the molecular substructures
of potential drugs; and AbMiner, a relational database of information
on antibodies available for proteomic studies.
Development of these computer resources has been motivated in part
by our studies of 60 human cancer cell lines (the NCI-60) used by
the NCI to screen >100,000 chemical compounds since 1990 to find
new drugs for cancer therapy. These cells provide detailed information
about mechanisms of drug action and resistance (9,10). We and our
collaborators have generated multi-faceted molecular target profiles
of the NCI-60 using 2-D gel electrophoresis (6), 'reverse-phase'
protein microarrays (11), cDNA microarrays (12,13), Affymetrix oligo
chips (14), real-time RT-PCR, array-CGH, SKY, SNP chips, and DNA
methylation-sequencing. Clinical molecular markers identified are
validated by tissue microarray (11). Such integrated databases will
have a great impact on cancer drug discovery and individualization
(15). In this talk, I will try to provide the necessary elements
of background in biology and will emphasize the roles of bioinformatics,
biostatistics, and other areas of computational biology in current,
cutting edge biomedical research. See http://discover.nci.nih.gov.
(1) Weinstein. (1998). Science, 282, 628.
(2) Weinstein, & Curr. (2002). Opinion in Pharmacol.,
2, 361.
(3) Tanabe, et al. (1999). BioTechniques, 27, 1210.
(4) Weinstein, et al. (1997). Science, 275, 343.
(5) Myers, et al. (1997). Electrophoresis, 18, 647.
(6) Bussey. (2003). Genome Biology, 4, R27.
(7) Zeeberg. (2003). Genome Biol., 4, R28.
(8) Blower, Jr. (2002). The Pharmacogenomics Journal (Nature),
2, 259.
(9) Paull, et al. (1989). J. Natl. Cancer Inst., 81, 1088.
(10) Weinstein, et al. (1992). Science, 258, 343.
(11) Nishizuka, et al. (2003). Cancer Res., 65, 5243.
(12) Ross, et al. (2000). Nature Genetics, 24, 227.
(13) Scherf, et al. (2000). Nature Genetics, 24, 236.
(14) Staunton, et al. (2001). Proc. Natl. Acad. Sci. U.S.A.,
98, 10787.
(15) Reinhold. (2003). Cancer Res., 63, 1000.
Author: Guill Wientjes, College of Pharmacy, The Ohio State University
Title: Drug Delivery to Tumors Determinants and Barriers
Presentation Materials: PPT
Streaming Video: Real
Media
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