1
|
Arora G, Bairagi N, Chatterjee S. A mathematical model to study low-dose metronomic scheduling for chemotherapy. Math Biosci 2024; 372:109186. [PMID: 38580078 DOI: 10.1016/j.mbs.2024.109186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 02/21/2024] [Accepted: 03/27/2024] [Indexed: 04/07/2024]
Abstract
Metronomic chemotherapy refers to the frequent administration of chemotherapeutic agents at a lower dose and presents an attractive alternative to conventional chemotherapy with encouraging response rates. However, the schedule of the therapy, including the dosage of the drug, is usually based on empiricism. The confounding effects of tumor-endothelial-immune interactions during metronomic administration of drugs have not yet been explored in detail, resulting in an incomplete assessment of drug dose and frequency evaluations. The present study aimed to gain a mechanistic understanding of different actions of metronomic chemotherapy using a mathematical model. We have established an analytical condition for determining the dosage and frequency of the drug depending on its clearance rate for complete tumor elimination. The model also brings forward the immune-mediated clearance of the tumor during the metronomic administration of the chemotherapeutic agent. The results from the global sensitivity analysis showed an increase in the sensitivity of drug and immune-mediated killing factors toward the tumor population during metronomic scheduling. Our results emphasize metronomic scheduling over the maximum tolerated dose (MTD) and define a model-based approach for approximating the optimal schedule of drug administration to eliminate tumors while minimizing harm to the immune cells and the patient's body.
Collapse
Affiliation(s)
- Garhima Arora
- Complex Analysis Group, Translational Health Science and Technology Institute, NCR Biotech Science Cluster, Faridabad, 121001, India
| | - Nandadulal Bairagi
- Department of Mathematics, Centre for Mathematical Biology and Ecology, Jadavpur University, Kolkata, 700032, India
| | - Samrat Chatterjee
- Complex Analysis Group, Translational Health Science and Technology Institute, NCR Biotech Science Cluster, Faridabad, 121001, India.
| |
Collapse
|
2
|
Huang L, Jiang T, Li P, Zhang J, Luo X, Yang F, Ren T, Xu K. Effectiveness and toxicity of metronomic oral cyclophosphamide for recurrent or platinum-refractory ovarian cancer: A meta-analysis. Heliyon 2022; 8:e10399. [PMID: 36082328 PMCID: PMC9445287 DOI: 10.1016/j.heliyon.2022.e10399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 06/23/2022] [Accepted: 08/17/2022] [Indexed: 11/08/2022] Open
Abstract
Purpose To systematically assess the effectiveness and toxicity of metronomic oral cyclophosphamide (MOC) on recurrent or platinum-refractory ovarian cancer. Methods We searched the Cochrane Library, Embase, PubMed, CNKI, Weipu, and Wanfang databases for eligible studies. A descriptive statistical method was used to analyze the pooled results. Ratios and means were merged to analyze the objective response rate (ORR), disease control rate (DCR), progression-free survival (PFS), overall survival (OS), and the rate of serious adverse events (SAEs). Subgroup analysis, sensitivity analysis, and examination of publication bias were conducted for heterogeneity test and quality assurance of the results. Results The ORR and DCR by MOC were 25% (95% CI 12–41) and 61% (95% CI 43–77), respectively. The median PFS and OS were 4.29 months (95% CI 2.62–5.97) and 11.26 months (95% CI 8.13–14.39), respectively. The rate of SAEs was 41% (95% CI 30–52). The most frequent SAEs were gastrointestinal toxicity 6% (95% CI 1–12), lymphopenia 6% (95% CI 1–13), and neutropenia 5% (95% CI 2–9). In the subgroup analysis, the ORR and DCR in the subgroup of MOC combined with bevacizumab/pazopanib were 42% (95% CI 26–58) and 82% (95% CI 63–95), respectively. The median PFS and OS were 7.32 months (95% CI 5.93–8.70) and 17.35 months (95% CI 12.89–21.82), respectively. Conclusion MOC has a certain effect in clinical response on patients with recurrent or platinum-refractory ovarian cancers, especially when MOC combined with bevacizumab/pazopanib. However, there is a high risk of SAEs.
Collapse
|
3
|
Tanyi JL, Chiang CLL, Chiffelle J, Thierry AC, Baumgartener P, Huber F, Goepfert C, Tarussio D, Tissot S, Torigian DA, Nisenbaum HL, Stevenson BJ, Guiren HF, Ahmed R, Huguenin-Bergenat AL, Zsiros E, Bassani-Sternberg M, Mick R, Powell DJ, Coukos G, Harari A, Kandalaft LE. Personalized cancer vaccine strategy elicits polyfunctional T cells and demonstrates clinical benefits in ovarian cancer. NPJ Vaccines 2021; 6:36. [PMID: 33723260 PMCID: PMC7960755 DOI: 10.1038/s41541-021-00297-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 02/17/2021] [Indexed: 01/31/2023] Open
Abstract
T cells are important for controlling ovarian cancer (OC). We previously demonstrated that combinatorial use of a personalized whole-tumor lysate-pulsed dendritic cell vaccine (OCDC), bevacizumab (Bev), and cyclophosphamide (Cy) elicited neoantigen-specific T cells and prolonged OC survival. Here, we hypothesize that adding acetylsalicylic acid (ASA) and low-dose interleukin (IL)-2 would increase the vaccine efficacy in a recurrent advanced OC phase I trial (NCT01132014). By adding ASA and low-dose IL-2 to the OCDC-Bev-Cy combinatorial regimen, we elicited vaccine-specific T-cell responses that positively correlated with patients' prolonged time-to-progression and overall survival. In the ID8 ovarian model, animals receiving the same regimen showed prolonged survival, increased tumor-infiltrating perforin-producing T cells, increased neoantigen-specific CD8+ T cells, and reduced endothelial Fas ligand expression and tumor-infiltrating T-regulatory cells. This combinatorial strategy was efficacious and also highlighted the predictive value of the ID8 model for future ovarian trial development.
Collapse
Affiliation(s)
- Janos L. Tanyi
- grid.25879.310000 0004 1936 8972Ovarian Cancer Research Center, Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
| | - Cheryl L.-L. Chiang
- grid.9851.50000 0001 2165 4204Department of Oncology, Lausanne University Hospital (CHUV), Ludwig Institute for Cancer Research, University of Lausanne, Lausanne, Switzerland
| | - Johanna Chiffelle
- grid.9851.50000 0001 2165 4204Department of Oncology, Lausanne University Hospital (CHUV), Ludwig Institute for Cancer Research, University of Lausanne, Lausanne, Switzerland
| | - Anne-Christine Thierry
- grid.8515.90000 0001 0423 4662Center of Experimental Therapeutics, Department of Oncology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Petra Baumgartener
- grid.8515.90000 0001 0423 4662Center of Experimental Therapeutics, Department of Oncology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Florian Huber
- grid.9851.50000 0001 2165 4204Department of Oncology, Lausanne University Hospital (CHUV), Ludwig Institute for Cancer Research, University of Lausanne, Lausanne, Switzerland
| | - Christine Goepfert
- grid.5734.50000 0001 0726 5157Institute of Animal Pathology, COMPATH, Vetsuisse Faculty, University of Bern, Bern, Switzerland ,grid.5333.60000000121839049School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - David Tarussio
- grid.8515.90000 0001 0423 4662Center of Experimental Therapeutics, Department of Oncology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Stephanie Tissot
- grid.8515.90000 0001 0423 4662Center of Experimental Therapeutics, Department of Oncology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Drew A. Torigian
- grid.411115.10000 0004 0435 0884Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA USA
| | - Harvey L. Nisenbaum
- grid.411115.10000 0004 0435 0884Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA USA
| | - Brian J. Stevenson
- grid.9851.50000 0001 2165 4204Department of Oncology, Lausanne University Hospital (CHUV), Ludwig Institute for Cancer Research, University of Lausanne, Lausanne, Switzerland
| | - Hajer Fritah Guiren
- grid.9851.50000 0001 2165 4204Department of Oncology, Lausanne University Hospital (CHUV), Ludwig Institute for Cancer Research, University of Lausanne, Lausanne, Switzerland
| | - Ritaparna Ahmed
- grid.9851.50000 0001 2165 4204Department of Oncology, Lausanne University Hospital (CHUV), Ludwig Institute for Cancer Research, University of Lausanne, Lausanne, Switzerland
| | - Anne-Laure Huguenin-Bergenat
- grid.9851.50000 0001 2165 4204Department of Oncology, Lausanne University Hospital (CHUV), Ludwig Institute for Cancer Research, University of Lausanne, Lausanne, Switzerland
| | - Emese Zsiros
- grid.25879.310000 0004 1936 8972Ovarian Cancer Research Center, Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
| | - Michal Bassani-Sternberg
- grid.9851.50000 0001 2165 4204Department of Oncology, Lausanne University Hospital (CHUV), Ludwig Institute for Cancer Research, University of Lausanne, Lausanne, Switzerland
| | - Rosemarie Mick
- grid.25879.310000 0004 1936 8972Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
| | - Daniel J. Powell
- grid.25879.310000 0004 1936 8972Ovarian Cancer Research Center, Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
| | - George Coukos
- grid.9851.50000 0001 2165 4204Department of Oncology, Lausanne University Hospital (CHUV), Ludwig Institute for Cancer Research, University of Lausanne, Lausanne, Switzerland
| | - Alexandre Harari
- grid.9851.50000 0001 2165 4204Department of Oncology, Lausanne University Hospital (CHUV), Ludwig Institute for Cancer Research, University of Lausanne, Lausanne, Switzerland ,grid.8515.90000 0001 0423 4662Center of Experimental Therapeutics, Department of Oncology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Lana E. Kandalaft
- grid.9851.50000 0001 2165 4204Department of Oncology, Lausanne University Hospital (CHUV), Ludwig Institute for Cancer Research, University of Lausanne, Lausanne, Switzerland ,grid.8515.90000 0001 0423 4662Center of Experimental Therapeutics, Department of Oncology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| |
Collapse
|
4
|
Mendez N, Alarcón P, Millán C, Burgos RA, Morera FJ, Ojeda J. Vincristine, carboplatin and cisplatin increase oxidative burst induced by PAF in canine neutrophils. Vet Immunol Immunopathol 2020; 221:110011. [PMID: 32007672 DOI: 10.1016/j.vetimm.2020.110011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 12/12/2019] [Accepted: 01/14/2020] [Indexed: 01/05/2023]
Abstract
Myelosupression resulting from chemotherapy has been widely described in veterinary medicine; however, there is limited information relating to alterations in neutrophil function after chemotherapy in dogs with cancer. The aim of this study was to determine the non-proliferative effects of vincristine, carboplatin, and cisplatin on canine neutrophils by evaluating activation of oxidative and non-oxidative responses. Neutrophils were isolated from venous blood. Levels of reactive oxygen species (ROS) and metalloproteinase 9 (MMP-9) were measured in vitro during neutrophil exposure to these chemotherapeutic agents for 15 min followed by stimulation with platelet activating factor (PAF). ROS production was detected via luminescence, and MMP- 9 liberation was determined by zymography. The chemotherapeutic agents caused an increase in PAF-induced ROS production, but no change in the non-oxidative response was observed. These results suggest that these chemotherapeutic agents may act as priming agents by increasing the oxidative response. These effects could be beneficial for dogs with cancer by supporting their immune systems; however, excessive ROS liberation has been associated with inflammation, neutrophil-mediated cell injury, carcinogenesis, and metastasis. Clinical studies are necessary to evaluate the significance of these findings.
Collapse
Affiliation(s)
- Nathalia Mendez
- Veterinary Clinical Sciences, Faculty of Veterinary Sciences, Universidad Austral de Chile, Valdivia, Chile
| | - Pablo Alarcón
- Laboratory of Molecular Pharmacology, Institute of Pharmacology and Morphophysiology, Faculty of Veterinary Science, Universidad Austral de Chile, Valdivia, Chile
| | - Catalina Millán
- Applied Biochemistry Laboratory, Institute of Pharmacology and Morphophysiology, Faculty of Veterinary Science, Universidad Austral de Chile, Valdivia, Chile; School of Medicine, Medicine Faculty, Universidad Austral de Chile, Valdivia, Chile
| | - Rafael A Burgos
- Laboratory of Molecular Pharmacology, Institute of Pharmacology and Morphophysiology, Faculty of Veterinary Science, Universidad Austral de Chile, Valdivia, Chile
| | - Francisco J Morera
- Applied Biochemistry Laboratory, Institute of Pharmacology and Morphophysiology, Faculty of Veterinary Science, Universidad Austral de Chile, Valdivia, Chile
| | - Javier Ojeda
- Veterinary Clinical Sciences, Faculty of Veterinary Sciences, Universidad Austral de Chile, Valdivia, Chile.
| |
Collapse
|
5
|
Schulthess P, Rottschäfer V, Yates JWT, van der Graaf PH. Optimization of Cancer Treatment in the Frequency Domain. AAPS JOURNAL 2019; 21:106. [PMID: 31512089 PMCID: PMC6739279 DOI: 10.1208/s12248-019-0372-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 08/14/2019] [Indexed: 01/23/2023]
Abstract
Thorough exploration of alternative dosing frequencies is often not performed in conventional pharmacometrics approaches. Quantitative systems pharmacology (QSP) can provide novel insights into optimal dosing regimen and drug behaviors which could add a new dimension to the design of novel treatments. However, methods for such an approach are currently lacking. Recently, we illustrated the utility of frequency-domain response analysis (FdRA), an analytical method used in control engineering, using several generic pharmacokinetic-pharmacodynamic case studies. While FdRA is not applicable to models harboring ever increasing variables such as those describing tumor growth, studying such models in the frequency domain provides valuable insight into optimal dosing frequencies. Through the analysis of three distinct tumor growth models (cell cycle-specific, metronomic, and acquired resistance), we demonstrate the application of a simulation-based analysis in the frequency domain to optimize cancer treatments. We study the response of tumor growth to dosing frequencies while simultaneously examining treatment safety, and found for all three models that above a certain dosing frequency, tumor size is insensitive to an increase in dosing frequency, e.g., for the cell cycle-specific model, one dose per 3 days, and an hourly dose yield the same reduction of tumor size to 3% of the initial size after 1 year of treatment. Additionally, we explore the effect of drug elimination rate changes on the tumor growth response. In summary, we show that the frequency-domain view of three models of tumor growth dynamics can help in optimizing drug dosing regimen to improve treatment success.
Collapse
Affiliation(s)
- Pascal Schulthess
- LYO-X GmbH, Basel, Switzerland.,Systems Biomedicine & Pharmacology, Leiden Academic Centre for Drug Research, Leiden University, 2333 CC, Leiden, The Netherlands
| | - Vivi Rottschäfer
- Mathematical Institute, Leiden University, Leiden, The Netherlands
| | - James W T Yates
- DMPK, Oncology R&D, AstraZeneca, Chesterford Research Park, Cambridge, UK
| | - Piet H van der Graaf
- Systems Biomedicine & Pharmacology, Leiden Academic Centre for Drug Research, Leiden University, 2333 CC, Leiden, The Netherlands. .,Certara QSP, Canterbury Innovation Centre, Canterbury, UK.
| |
Collapse
|
6
|
Chu T, Chan H, Hu T, Wang E, Ma Y, Huang S, Wu J, Chang Y, Weng W, Wen Z, Wu D, Chen YA, Tai M. Celecoxib enhances the therapeutic efficacy of epirubicin for Novikoff hepatoma in rats. Cancer Med 2018; 7:2567-2580. [PMID: 29683262 PMCID: PMC6010827 DOI: 10.1002/cam4.1487] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 02/09/2018] [Accepted: 02/26/2018] [Indexed: 01/22/2023] Open
Abstract
Epirubicin is a chemotherapy agent for hepatocellular carcinoma (HCC). However, the outcome of HCC patients receiving epirubicin remains unsatisfactory. Moreover, our previous study indicated that celecoxib suppresses HCC progression and liver cancer stemness. This study evaluated the potential of celecoxib to serve as a complementary therapy during epirubicin treatment. Cell proliferation, apoptosis, invasiveness, and anchorage-independent growth were analyzed in hepatoma cells. Therapeutic efficacy was validated in rat orthotopic Novikoff hepatoma. After animal sacrifice, the antitumor mechanism of celecoxib and epirubicin combined therapy was investigated by histological analysis. Celecoxib enhanced the cytotoxic activity of epirubicin in HCC cells by promoting apoptosis. Besides, celecoxib potentiated the antineoplastic function of epirubicin in inhibiting the invasiveness and anchorage-independent growth of HCC cells. Ultrasound monitoring showed that combined therapy was more potent than either therapy alone in perturbing HCC progression. Consistently, the size and weight of dissected HCC tissues from rats receiving combined therapy were smallest among all groups. HCC treated with combined therapy exhibited the highest prevalence of apoptotic cells, which was accompanied by reduced proliferating and angiogenic activities in tumor tissues. Moreover, the expression levels of cancer stemness markers (CD44 and CD133) and drug transporter MDR-1 were significantly diminished in rats receiving combined therapy. Besides, celecoxib treatment increased the infiltration of cytotoxic T lymphocytes (CTLs) and reduced the number of regulatory T cells (Tregs), tumor-associated macrophages (TAMs), and the expression of immune checkpoint PD-L1 in HCC tissues during epirubicin therapy. Celecoxib augmented the therapeutic efficacy while modulated cancer stemness and antitumor immunity. Thus, celecoxib may serve as complementary therapy to improve the outcome of patients with advanced HCC during epirubicin treatment.
Collapse
Affiliation(s)
- Tian‐Huei Chu
- Center for NeuroscienceNational Sun Yat‐Sen UniversityKaohsiungTaiwan
- Institute of Biomedical SciencesNational Sun Yat‐Sen UniversityKaohsiungTaiwan
| | - Hoi‐Hung Chan
- Division of Gastroenterology and HepatologyDepartment of Internal MedicineKaohsiung Veterans General HospitalKaohsiungTaiwan
- School of MedicineNational Yang‐Ming UniversityTaipeiTaiwan
- College of Pharmacy & Health CareTajen UniversityPingtung CountyTaiwan
- Department of Biological SciencesNational Sun Yat‐sen UniversityKaohsiungTaiwan
| | - Tsung‐Hui Hu
- Division of Hepato‐GastroenterologyDepartment of Internal MedicineChang Gung Memorial Hospital Kaohsiung Medical CenterChang Gung University College of MedicineKaohsiungTaiwan
| | - E‐Ming Wang
- Division of Gastroenterology and HepatologyDepartment of Internal MedicineKaohsiung Veterans General HospitalKaohsiungTaiwan
- Department of Biological SciencesNational Sun Yat‐sen UniversityKaohsiungTaiwan
| | - Yi‐Ling Ma
- Division of NephrologyKaohsiung Veterans General HospitalKaohsiungTaiwan
| | - Shih‐Chung Huang
- Institute of Biomedical SciencesNational Sun Yat‐Sen UniversityKaohsiungTaiwan
- Department of Internal MedicineKaohsiung Armed Forces General HospitalKaohsiungTaiwan
| | - Jian‐Ching Wu
- Doctoral Degree Program in Marine BiotechnologyNational Sun Yat‐Sen University and Academia SinicaKaohsiungTaiwan
| | - Yi‐Chen Chang
- Doctoral Degree Program in Marine BiotechnologyNational Sun Yat‐Sen University and Academia SinicaKaohsiungTaiwan
| | - Wen‐Tsan Weng
- Department of Medical ResearchKaohsiung Chang Gung Memorial HospitalKaohsiungTaiwan
- Core Laboratory for Phenomics and DiagonsticsDepartment of PediatricsKaohsiung Chang Gung Memorial HospitalKaohsiungTaiwan
| | - Zhi‐Hong Wen
- Department of Marine Biotechnology and ResourcesAsia‐Pacific Ocean Research CenterNational Sun Yat‐Sen UniversityKaohsiungTaiwan
| | - Deng‐Chyang Wu
- Institute of Biomedical SciencesNational Sun Yat‐Sen UniversityKaohsiungTaiwan
- Center for Stem Cell ResearchKaohsiung Medical UniversityKaohsiungTaiwan
- Division of GastroenterologyDepartment of Internal MedicineKaohsiung Medical University HospitalKaohsiungTaiwan
- Department of MedicineFaculty of MedicineCollege of MedicineKaohsiung Medical UniversityKaohsiungTaiwan
| | - Yi‐Ming Arthur Chen
- Institute of Biomedical SciencesNational Sun Yat‐Sen UniversityKaohsiungTaiwan
- Center for Infectious Disease and Cancer ResearchKaohsiung Medical UniversityKaohsiungTaiwan
- Department of Microbiology and ImmunologyInstitute of Medical Research and Institute of Clinical MedicineCollege of MedicineKaohsiung Medical UniversityKaohsiungTaiwan
| | - Ming‐Hong Tai
- Center for NeuroscienceNational Sun Yat‐Sen UniversityKaohsiungTaiwan
- Institute of Biomedical SciencesNational Sun Yat‐Sen UniversityKaohsiungTaiwan
- Doctoral Degree Program in Marine BiotechnologyNational Sun Yat‐Sen University and Academia SinicaKaohsiungTaiwan
- Center for Stem Cell ResearchKaohsiung Medical UniversityKaohsiungTaiwan
| |
Collapse
|
7
|
Böttcher MA, Held-Feindt J, Synowitz M, Lucius R, Traulsen A, Hattermann K. Modeling treatment-dependent glioma growth including a dormant tumor cell subpopulation. BMC Cancer 2018; 18:376. [PMID: 29614985 PMCID: PMC5883287 DOI: 10.1186/s12885-018-4281-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 03/21/2018] [Indexed: 02/07/2023] Open
Abstract
Background Tumors comprise a variety of specialized cell phenotypes adapted to different ecological niches that massively influence the tumor growth and its response to treatment. Methods In the background of glioblastoma multiforme, a highly malignant brain tumor, we consider a rapid proliferating phenotype that appears susceptible to treatment, and a dormant phenotype which lacks this pronounced proliferative ability and is not affected by standard therapeutic strategies. To gain insight in the dynamically changing proportions of different tumor cell phenotypes under different treatment conditions, we develop a mathematical model and underline our assumptions with experimental data. Results We show that both cell phenotypes contribute to the distinct composition of the tumor, especially in cycling low and high dose treatment, and therefore may influence the tumor growth in a phenotype specific way. Conclusion Our model of the dynamic proportions of dormant and rapidly growing glioblastoma cells in different therapy settings suggests that phenotypically different cells should be considered to plan dose and duration of treatment schedules.
Collapse
Affiliation(s)
- Marvin A Böttcher
- Department Evolutionary Theory, Max Planck Institute for Evolutionary Biology, 24306, Plön, Germany
| | - Janka Held-Feindt
- Department of Neurosurgery, University Medical Center Schleswig-Holstein UKSH, Campus Kiel, 24105, Kiel, Germany
| | - Michael Synowitz
- Department of Neurosurgery, University Medical Center Schleswig-Holstein UKSH, Campus Kiel, 24105, Kiel, Germany
| | - Ralph Lucius
- Department of Anatomy, University of Kiel, 24098, Kiel, Germany
| | - Arne Traulsen
- Department Evolutionary Theory, Max Planck Institute for Evolutionary Biology, 24306, Plön, Germany
| | | |
Collapse
|
8
|
André N, Tsai K, Carré M, Pasquier E. Metronomic Chemotherapy: Direct Targeting of Cancer Cells after all? Trends Cancer 2017; 3:319-325. [DOI: 10.1016/j.trecan.2017.03.011] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 03/25/2017] [Accepted: 03/29/2017] [Indexed: 12/22/2022]
|
9
|
Ledzewicz U, Schättler H. Application of mathematical models to metronomic chemotherapy: What can be inferred from minimal parameterized models? Cancer Lett 2017; 401:74-80. [PMID: 28323033 DOI: 10.1016/j.canlet.2017.03.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 03/10/2017] [Accepted: 03/10/2017] [Indexed: 01/11/2023]
Abstract
Metronomic chemotherapy refers to the frequent administration of chemotherapy at relatively low, minimally toxic doses without prolonged treatment interruptions. Different from conventional or maximum-tolerated-dose chemotherapy which aims at an eradication of all malignant cells, in a metronomic dosing the goal often lies in the long-term management of the disease when eradication proves elusive. Mathematical modeling and subsequent analysis (theoretical as well as numerical) have become an increasingly more valuable tool (in silico) both for determining conditions under which specific treatment strategies should be preferred and for numerically optimizing treatment regimens. While elaborate, computationally-driven patient specific schemes that would optimize the timing and drug dose levels are still a part of the future, such procedures may become instrumental in making chemotherapy effective in situations where it currently fails. Ideally, mathematical modeling and analysis will develop into an additional decision making tool in the complicated process that is the determination of efficient chemotherapy regimens. In this article, we review some of the results that have been obtained about metronomic chemotherapy from mathematical models and what they infer about the structure of optimal treatment regimens.
Collapse
Affiliation(s)
- Urszula Ledzewicz
- Dept. of Mathematics and Statistics, Southern Illinois University Edwardsville, Edwardsville, IL, 62026-1653, USA; Institute of Mathematics, Lodz University of Technology, 90-924, Lodz, Poland.
| | - Heinz Schättler
- Dept. of Electrical and Systems Engineering Washington University, St. Louis, MO, 63130, USA.
| |
Collapse
|
10
|
Resistance to metronomic chemotherapy and ways to overcome it. Cancer Lett 2017; 400:311-318. [PMID: 28259819 DOI: 10.1016/j.canlet.2017.02.027] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 02/20/2017] [Accepted: 02/22/2017] [Indexed: 12/24/2022]
Abstract
Therapeutic resistance is amongst the major determinants of cancer mortality. Contrary to initial expectations, antivascular therapies are equally prone to inherent or acquired resistance as other cancer treatment modalities. However, studies into resistance to vascular endothelial growth factor pathway inhibitors revealed distinct mechanisms of resistance compared to conventional cytotoxic therapy. While some of these novel mechanisms of resistance also appear to be functional regarding metronomic chemotherapy, herein we summarize available evidence for mechanisms of resistance specifically described in the context of metronomic chemotherapy. Numerous preclinically identified molecular targets and pathways represent promising avenues to overcome resistance and enhance the benefits achieved with metronomic chemotherapy eventually. However, there are considerable challenges to clinically translate the preclinical findings.
Collapse
|
11
|
Hansen E, Woods RJ, Read AF. How to Use a Chemotherapeutic Agent When Resistance to It Threatens the Patient. PLoS Biol 2017; 15:e2001110. [PMID: 28182734 PMCID: PMC5300106 DOI: 10.1371/journal.pbio.2001110] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 01/06/2017] [Indexed: 12/21/2022] Open
Abstract
When resistance to anticancer or antimicrobial drugs evolves in a patient, highly effective chemotherapy can fail, threatening patient health and lifespan. Standard practice is to treat aggressively, effectively eliminating drug-sensitive target cells as quickly as possible. This prevents sensitive cells from acquiring resistance de novo but also eliminates populations that can competitively suppress resistant populations. Here we analyse that evolutionary trade-off and consider recent suggestions that treatment regimens aimed at containing rather than eliminating tumours or infections might more effectively delay the emergence of resistance. Our general mathematical analysis shows that there are situations in which regimens aimed at containment will outperform standard practice even if there is no fitness cost of resistance, and, in those cases, the time to treatment failure can be more than doubled. But, there are also situations in which containment will make a bad prognosis worse. Our analysis identifies thresholds that define these situations and thus can guide treatment decisions. The analysis also suggests a variety of interventions that could be used in conjunction with cytotoxic drugs to inhibit the emergence of resistance. Fundamental principles determine, across a wide range of disease settings, the circumstances under which standard practice best delays resistance emergence-and when it can be bettered.
Collapse
Affiliation(s)
- Elsa Hansen
- Center for Infectious Disease Dynamics, Departments of Biology and Entomology, Pennsylvania State University, Pennsylvania, United States of America
- * E-mail:
| | - Robert J. Woods
- Division of Infectious Diseases, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Andrew F. Read
- Center for Infectious Disease Dynamics, Departments of Biology and Entomology, Pennsylvania State University, Pennsylvania, United States of America
| |
Collapse
|
12
|
Ledzewicz U, Wang S, Schattler H, Andre N, Heng MA, Pasquier E. On drug resistance and metronomic chemotherapy: A mathematical modeling and optimal control approach. MATHEMATICAL BIOSCIENCES AND ENGINEERING : MBE 2017; 14:217-235. [PMID: 27879129 DOI: 10.3934/mbe.2017014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Effects that tumor heterogeneity and drug resistance have on the structure of chemotherapy protocols are discussed from a mathematical modeling and optimal control point of view. In the case when two compartments consisting of sensitive and resistant cells are considered, optimal protocols consist of full dose chemotherapy as long as the relative proportion of sensitive cells is high. When resistant cells become more dominant, optimal controls switch to lower dose regimens defined by so-called singular controls. The role that singular controls play in the structure of optimal therapy protocols for cell populations with a large number of traits is explored in mathematical models.
Collapse
Affiliation(s)
- Urszula Ledzewicz
- Institute of Mathematics, Lodz University of Technology, 90-924 Lodz, Poland.
| | | | | | | | | | | |
Collapse
|
13
|
Carrère C. Optimization of an in vitro chemotherapy to avoid resistant tumours. J Theor Biol 2016; 413:24-33. [PMID: 27864095 DOI: 10.1016/j.jtbi.2016.11.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 11/02/2016] [Accepted: 11/07/2016] [Indexed: 11/28/2022]
Abstract
Chemotherapy use against solid tumours often results in the resistance of the cancer cells to the molecule used. In this paper, we will set up and analyse an ODE model for heterogeneous in vitro tumours, consisting of cells that are sensitive or resistant to a certain drug. We will then use this model to develop different protocols, that aim at reducing the tumour volume while preserving its heterogeneity. These drug administration schedules are determined through analysis of the system dynamics, and optimal control theory.
Collapse
Affiliation(s)
- Cécile Carrère
- Aix Marseille Université, CNRS, Centrale Marseille, Institut de Mathématique de Marseille, UMR 7373, 13453 Marseille France
| |
Collapse
|
14
|
Pantziarka P, Hutchinson L, André N, Benzekry S, Bertolini F, Bhattacharjee A, Chiplunkar S, Duda DG, Gota V, Gupta S, Joshi A, Kannan S, Kerbel R, Kieran M, Palazzo A, Parikh A, Pasquier E, Patil V, Prabhash K, Shaked Y, Sholler GS, Sterba J, Waxman DJ, Banavali S. Next generation metronomic chemotherapy-report from the Fifth Biennial International Metronomic and Anti-angiogenic Therapy Meeting, 6-8 May 2016, Mumbai. Ecancermedicalscience 2016; 10:689. [PMID: 27994645 PMCID: PMC5130328 DOI: 10.3332/ecancer.2016.689] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Indexed: 12/31/2022] Open
Abstract
The 5th Biennial Metronomic and Anti-angiogenic Therapy Meeting was held on 6th – 8th May in the Indian city of Mumbai. The meeting brought together a wide range of clinicians and researchers interested in metronomic chemotherapy, anti-angiogenics, drug repurposing and combinations thereof. Clinical experiences, including many from India, were reported and discussed in three symposia covering breast cancer, head and neck cancers and paediatrics. On the pre-clinical side research into putative mechanisms of action, and the interactions between low dose metronomic chemotherapy and angiogenesis and immune responses, were discussed in a number of presentations. Drug repurposing was discussed both in terms of clinical results, particularly with respect to angiosarcoma and high-risk neuroblastoma, and in pre-clinical settings, particularly the potential for peri-operative interventions. However, it was clear that there remain a number of key areas of challenge, particularly in terms of definitions, perceptions in the wider oncological community, mechanisms of action and predictive biomarkers. While the potential for metronomics and drug repurposing in low and middle income countries remains a key theme, it is clear that there is also considerable potential for clinically relevant improvements in patient outcomes even in high income economies.
Collapse
Affiliation(s)
- Pan Pantziarka
- Anticancer Fund, Brussels, 1853 Strombeek-Bever, Belgium; The George Pantziarka TP53 Trust, London, UK
| | | | - Nicolas André
- Service d'hématologie et Oncologie Pédiatrique, Centre Hospitalo-Universitaire Timone Enfants, AP-HM, Aix-Marseille Université, INSERM, CRO2 UMR_S 911, Marseille, France; Metronomics Global Health Initiative, Marseille, France
| | - Sébastien Benzekry
- Inria team MONC and Institut de Mathématiques de Bordeaux, Talence, France
| | | | | | | | - Dan G Duda
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Vikram Gota
- ACTREC, Tata Memorial Centre, Kharghar, Navi Mumbai 410210, India
| | - Sudeep Gupta
- ACTREC, Tata Memorial Centre, Kharghar, Navi Mumbai 410210, India
| | | | - Sadhana Kannan
- ACTREC, Tata Memorial Centre, Kharghar, Navi Mumbai 410210, India
| | - Robert Kerbel
- Biological Sciences Platform, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
| | - Mark Kieran
- Dana-Farber Cancer Institute, Boston, MA, USA
| | - Antonella Palazzo
- Division of Medical Senology, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy
| | | | - Eddy Pasquier
- INSERM UMR 911, Centre de Recherche en Oncologie Biologique et Oncopharmacologie, Aix-Marseille University, Marseille, France; Metronomics Global Health Initiative, Marseille, France
| | | | | | - Yuval Shaked
- Department of Cell Biology and Cancer Science, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | | | - Jaroslav Sterba
- Department of Pediatric Oncology, University Hospital Brno and Faculty of Medicine, Masaryk University, Cernopolni 9, 613 00 Brno, Czech Republic; International Clinical Research Center, St. Anne's University Hospital and RECAMO, Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - David J Waxman
- Department of Biology, Boston University, Boston, MA 02215, USA
| | - Shripad Banavali
- Tata Memorial Hospital, Mumbai, India; Metronomics Global Health Initiative, Marseille, France
| |
Collapse
|
15
|
A phase Ia/Ib clinical trial of metronomic chemotherapy based on a mathematical model of oral vinorelbine in metastatic non-small cell lung cancer and malignant pleural mesothelioma: rationale and study protocol. BMC Cancer 2016; 16:278. [PMID: 27094927 PMCID: PMC4837593 DOI: 10.1186/s12885-016-2308-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 04/11/2016] [Indexed: 11/17/2022] Open
Abstract
Background Metronomic oral vinorelbine is effective in metastatic NSCLC and malignant pleural mesothelioma, but all the studies published thus far were based upon a variety of empirical and possibly suboptimal schedules, with inconsistent results. Mathematical modelling showed by simulation that a new metronomic protocol could lead to a better safety and efficacy profile. Design This phase Ia/Ib trial was designed to confirm safety (phase Ia) and evaluate efficacy (phase Ib) of a new metronomic oral vinorelbine schedule. Patients with metastatic NSCLC or malignant pleural mesothelioma in whom standard treatments failed and who exhibited ECOG performance status 0–2 and adequate organ function will be eligible. Our mathematical PK-PD model suggested an alternative weekly D1, D2 and D4 schedule (named Vinorelbine Theoretical Protocol) with a respective dose of 60, 30 and 60 mg. Trial recruitment will be two-staged, as 12 patients are planned to participate in phase Ia to confirm safety and consolidate the calibration of the model parameters. Depending on the phase Ia results and after a favourable decision from a consultative committee, the extension phase (phase Ib) will be an efficacy study including 20 patients who will receive the Optimal Vinorelbine Theoretical Protocol. The primary endpoint is the tolerance (assessed by CTC v4.0) for the phase Ia and the objective response according to RECIST 1.1 for phase Ib. An ancillary study on circulating angiogenesis biomarkers will be a subproject of the trial. Discussion This ongoing trial is the first to prospectively test a mathematically optimized schedule in metronomic chemotherapy. As such, this trial can be considered as a proof-of-concept study demonstrating the feasibility to run a computational-driven protocol to ensure an optimal efficacy/toxicity balance in patients with cancer. Trial registration EudraCT N°: 2015-000138-31
Collapse
|
16
|
Ledzewicz U, Amini B, Schättler H. Dynamics and control of a mathematical model for metronomic chemotherapy. MATHEMATICAL BIOSCIENCES AND ENGINEERING : MBE 2015; 12:1257-1275. [PMID: 26775862 DOI: 10.3934/mbe.2015.12.1257] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
A 3-compartment model for metronomic chemotherapy that takes into account cancerous cells, the tumor vasculature and tumor immune-system interactions is considered as an optimal control problem. Metronomic chemo-therapy is the regular, almost continuous administration of chemotherapeutic agents at low dose, possibly with small interruptions to increase the efficacy of the drugs. There exists medical evidence that such administrations of specific cytotoxic agents (e.g., cyclophosphamide) have both antiangiogenic and immune stimulatory effects. A mathematical model for angiogenic signaling formulated by Hahnfeldt et al. is combined with the classical equations for tumor immune system interactions by Stepanova to form a minimally parameterized model to capture these effects of low dose chemotherapy. The model exhibits bistable behavior with the existence of both benign and malignant locally asymptotically stable equilibrium points. In this paper, the transfer of states from the malignant into the benign regions is used as a motivation for the construction of an objective functional that induces this process and the analysis of the corresponding optimal control problem is initiated.
Collapse
Affiliation(s)
- Urszula Ledzewicz
- Dept. of Mathematics and Statistics, Southern Illinois University, Edwardsville, Il 62025, United States
| | | | | |
Collapse
|
17
|
Metronomic reloaded: Theoretical models bringing chemotherapy into the era of precision medicine. Semin Cancer Biol 2015; 35:53-61. [DOI: 10.1016/j.semcancer.2015.09.002] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 09/02/2015] [Accepted: 09/03/2015] [Indexed: 11/18/2022]
|
18
|
Barbolosi D, Ciccolini J, Lacarelle B, Barlési F, André N. Computational oncology — mathematical modelling of drug regimens for precision medicine. Nat Rev Clin Oncol 2015; 13:242-54. [DOI: 10.1038/nrclinonc.2015.204] [Citation(s) in RCA: 144] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
|
19
|
Dose-Dependent Mutation Rates Determine Optimum Erlotinib Dosing Strategies for EGFR Mutant Non-Small Cell Lung Cancer Patients. PLoS One 2015; 10:e0141665. [PMID: 26536620 PMCID: PMC4633116 DOI: 10.1371/journal.pone.0141665] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 10/12/2015] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND The advent of targeted therapy for cancer treatment has brought about a paradigm shift in the clinical management of human malignancies. Agents such as erlotinib used for EGFR-mutant non-small cell lung cancer or imatinib for chronic myeloid leukemia, for instance, lead to rapid tumor responses. Unfortunately, however, resistance often emerges and renders these agents ineffective after a variable amount of time. The FDA-approved dosing schedules for these drugs were not designed to optimally prevent the emergence of resistance. To this end, we have previously utilized evolutionary mathematical modeling of treatment responses to elucidate the dosing schedules best able to prevent or delay the onset of resistance. Here we expand on our approaches by taking into account dose-dependent mutation rates at which resistant cells emerge. The relationship between the serum drug concentration and the rate at which resistance mutations arise can lead to non-intuitive results about the best dose administration strategies to prevent or delay the emergence of resistance. METHODS We used mathematical modeling, available clinical trial data, and different considerations of the relationship between mutation rate and drug concentration to predict the effectiveness of different dosing strategies. RESULTS We designed several distinct measures to interrogate the effects of different treatment dosing strategies and found that a low-dose continuous strategy coupled with high-dose pulses leads to the maximal delay until clinically observable resistance. Furthermore, the response to treatment is robust against different assumptions of the mutation rate as a function of drug concentration. CONCLUSIONS For new and existing targeted drugs, our methodology can be employed to compare the effectiveness of different dose administration schedules and investigate the influence of changing mutation rates on outcomes.
Collapse
|
20
|
Dynamical properties of a minimally parameterized mathematical model for metronomic chemotherapy. J Math Biol 2015; 72:1255-80. [DOI: 10.1007/s00285-015-0907-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Revised: 05/19/2015] [Indexed: 11/26/2022]
|
21
|
Oronsky BT, Oronsky AL, Lybeck M, Oronsky NC, Scicinski JJ, Carter C, Day RM, Rodriguez Orengo JF, Rodriguez-Torres M, Fanger GF, Reid TR. Episensitization: Defying Time's Arrow. Front Oncol 2015; 5:134. [PMID: 26125013 PMCID: PMC4464068 DOI: 10.3389/fonc.2015.00134] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2015] [Accepted: 05/27/2015] [Indexed: 12/17/2022] Open
Abstract
The development of cancer is driven by complex genetic and epigenetic changes that result in aberrant and uncontrolled cellular growth. Epigenetic changes, in particular, are implicated in the silencing or activation of key genes that control cellular growth and apoptosis and contribute to transformative potential. The purpose of this review is to define and assess the treatment strategy of “episensitization,” or the ability to sensitize cancer cells to subsequent therapy by resetting the epigenetic infrastructure of the tumor. One important facet is resensitization by epigenetic mechanisms, which goes against the norm, i.e., challenges the long-held doctrine in oncology that the reuse of previously tried and failed therapies is a clinically pointless endeavor. Thus, episensitization is a hybrid term, which covers recent clinically relevant observations and refers to the epigenomic mechanism of resensitization. Among the many formidable challenges in the treatment of cancer, the most inevitable is the development of acquired therapeutic resistance. Here, we present the basic principles behind episensitization and highlight the evidence suggesting that epigenetically mediated histone hypoacetylation and DNA hypermethylation events may reverse clinical drug resistance. The potential reversibility of epigenetic changes and the microenvironmental impact of epigenetic control on gene expression may mediate a return to a baseline state of treatment susceptibility. Episensitization is a novel and highly practical management strategy both to prevent the practice of permanent treatment discontinuation with the occurrence of resistance, which rapidly exhausts remaining options in the pharmaceutical armamentarium and to significantly extend patient survival. Accordingly, this review highlights several epigenetic agents including decitabine, vorinostat, entinostat, 5-azacitidine, oncolytic viruses, and RRx-001.
Collapse
Affiliation(s)
| | | | | | | | | | - Corey Carter
- Walter Reed National Military Medical Center, National Cancer Institute , Bethesda, MD , USA
| | - Regina M Day
- Uniformed Services University of the Health Sciences , Bethesda, MD , USA
| | | | | | | | - Tony R Reid
- Moores Cancer Center, University of California San Diego , La Jolla, CA , USA
| |
Collapse
|
22
|
Gramicidin A: A New Mission for an Old Antibiotic. J Kidney Cancer VHL 2015; 2:15-24. [PMID: 28326255 PMCID: PMC5345515 DOI: 10.15586/jkcvhl.2015.21] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Accepted: 01/15/2015] [Indexed: 01/01/2023] Open
Abstract
Gramicidin A (GA) is a channel-forming ionophore that renders biological membranes permeable to specific cations which disrupts cellular ionic homeostasis. It is a well-known antibiotic, however it’s potential as a therapeutic agent for cancer has not been widely evaluated. In two recently published studies, we showed that GA treatment is toxic to cell lines and tumor xenografts derived from renal cell carcinoma (RCC), a devastating disease that is highly resistant to conventional therapy. GA was found to possess the qualities of both a cytotoxic drug and a targeted angiogenesis inhibitor, and this combination significantly compromised RCC growth in vitro and in vivo. In this review, we summarize our recent research on GA, discuss the possible mechanisms whereby it exerts its anti-tumor effects, and share our perspectives on the future opportunities and challenges to the use of GA as a new anticancer agent.
Collapse
|
23
|
Radivoyevitch T, Li H, Sachs RK. Etiology and treatment of hematological neoplasms: stochastic mathematical models. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2014; 844:317-46. [PMID: 25480649 DOI: 10.1007/978-1-4939-2095-2_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Leukemias are driven by stemlike cancer cells (SLCC), whose initiation, growth, response to treatment, and posttreatment behavior are often "stochastic", i.e., differ substantially even among very similar patients for reasons not observable with present techniques. We review the probabilistic mathematical methods used to analyze stochastics and give two specific examples. The first example concerns a treatment protocol, e.g., for acute myeloid leukemia (AML), where intermittent cytotoxic drug dosing (e.g., once each weekday) is used with intent to cure. We argue mathematically that, if independent SLCC are growing stochastically during prolonged treatment, then, other things being equal, front-loading doses are more effective for tumor eradication than back loading. We also argue that the interacting SLCC dynamics during treatment is often best modeled by considering SLCC in microenvironmental niches, with SLCC-SLCC interactions occurring only among SLCC within the same niche, and we present a stochastic dynamics formalism, involving "Poissonization," applicable in such situations. Interactions at a distance due to partial control of total cell numbers are also considered. The second half of this chapter concerns chromosomal aberrations, lesions known to cause some leukemias. A specific example is the induction of a Philadelphia chromosome by ionizing radiation, subsequent development of chronic myeloid leukemia (CML), CML treatment, and treatment outcome. This time evolution involves a coordinated sequence of > 10 steps, each stochastic in its own way, at the subatomic, molecular, macromolecular, cellular, tissue, and population scales, with corresponding time scales ranging from picoseconds to decades. We discuss models of these steps and progress in integrating models across scales.
Collapse
Affiliation(s)
- Tomas Radivoyevitch
- Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, OH, USA,
| | | | | |
Collapse
|
24
|
Pantziarka P, Bouche G, Meheus L, Sukhatme V, Sukhatme VP. Repurposing drugs in oncology (ReDO)-cimetidine as an anti-cancer agent. Ecancermedicalscience 2014; 8:485. [PMID: 25525463 PMCID: PMC4268104 DOI: 10.3332/ecancer.2014.485] [Citation(s) in RCA: 189] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Indexed: 12/19/2022] Open
Abstract
Cimetidine, the first H2 receptor antagonist in widespread clinical use, has anti-cancer properties that have been elucidated in a broad range of pre-clinical and clinical studies for a number of different cancer types. These data are summarised and discussed in relation to a number of distinct mechanisms of action. Based on the evidence presented, it is proposed that cimetidine would synergise with a range of other drugs, including existing chemotherapeutics, and that further exploration of the potential of cimetidine as an anti-cancer therapeutic is warranted. Furthermore, there is compelling evidence that cimetidine administration during the peri-operative period may provide a survival benefit in some cancers. A number of possible combinations with other drugs are discussed in the supplementary material accompanying this paper.
Collapse
Affiliation(s)
- Pan Pantziarka
- Anticancer Fund, Brussels, 1853 Strombeek-Bever, Belgium ; The George Pantziarka TP53 Trust, London KT1 2JP, UK
| | | | - Lydie Meheus
- Anticancer Fund, Brussels, 1853 Strombeek-Bever, Belgium
| | | | - Vikas P Sukhatme
- GlobalCures, Inc; Newton MA 02459, USA ; Beth Israel Deaconess Medical Centre and Harvard Medical School, Boston, MA 02215, USA
| |
Collapse
|
25
|
Ledzewicz U, Schättler H. Tumor Microenvironment and Anticancer Therapies: An Optimal Control Approach. ACTA ACUST UNITED AC 2014. [DOI: 10.1007/978-1-4939-0458-7_10] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
|
26
|
Foo J, Michor F. Evolution of acquired resistance to anti-cancer therapy. J Theor Biol 2014; 355:10-20. [PMID: 24681298 PMCID: PMC4058397 DOI: 10.1016/j.jtbi.2014.02.025] [Citation(s) in RCA: 174] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Revised: 02/19/2014] [Accepted: 02/20/2014] [Indexed: 12/21/2022]
Abstract
Acquired drug resistance is a major limitation for the successful treatment of cancer. Resistance can emerge due to a variety of reasons including host environmental factors as well as genetic or epigenetic alterations in the cancer cells. Evolutionary theory has contributed to the understanding of the dynamics of resistance mutations in a cancer cell population, the risk of resistance pre-existing before the initiation of therapy, the composition of drug cocktails necessary to prevent the emergence of resistance, and optimum drug administration schedules for patient populations at risk of evolving acquired resistance. Here we review recent advances towards elucidating the evolutionary dynamics of acquired drug resistance and outline how evolutionary thinking can contribute to outstanding questions in the field.
Collapse
Affiliation(s)
- Jasmine Foo
- School of Mathematics, University of Minnesota, Minneapolis, MN 55455, USA.
| | - Franziska Michor
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA 02215, USA; Department of Biostatistics, Harvard School of Public Health, Boston, MA 02215, USA.
| |
Collapse
|
27
|
Kareva I, Morin B, Castillo-Chavez C. Resource consumption, sustainability, and cancer. Bull Math Biol 2014; 77:319-38. [PMID: 25033780 DOI: 10.1007/s11538-014-9983-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2013] [Accepted: 05/29/2014] [Indexed: 01/13/2023]
Abstract
Preserving a system's viability in the presence of diversity erosion is critical if the goal is to sustainably support biodiversity. Reduction in population heterogeneity, whether inter- or intraspecies, may increase population fragility, either decreasing its ability to adapt effectively to environmental changes or facilitating the survival and success of ordinarily rare phenotypes. The latter may result in over-representation of individuals who may participate in resource utilization patterns that can lead to over-exploitation, exhaustion, and, ultimately, collapse of both the resource and the population that depends on it. Here, we aim to identify regimes that can signal whether a consumer-resource system is capable of supporting viable degrees of heterogeneity. The framework used here is an expansion of a previously introduced consumer-resource type system of a population of individuals classified by their resource consumption. Application of the Reduction Theorem to the system enables us to evaluate the health of the system through tracking both the mean value of the parameter of resource (over)consumption, and the population variance, as both change over time. The article concludes with a discussion that highlights applicability of the proposed system to investigation of systems that are affected by particularly devastating overly adapted populations, namely cancerous cells. Potential intervention approaches for system management are discussed in the context of cancer therapies.
Collapse
Affiliation(s)
- Irina Kareva
- Mathematical, Computational Modeling Sciences Center, Arizona State University, PO Box 871904, Tempe, AZ, 85287, USA,
| | | | | |
Collapse
|
28
|
Pantziarka P, Bouche G, Meheus L, Sukhatme V, Sukhatme VP, Vikas P. The Repurposing Drugs in Oncology (ReDO) Project. Ecancermedicalscience 2014; 8:442. [PMID: 25075216 PMCID: PMC4096030 DOI: 10.3332/ecancer.2014.442] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Indexed: 12/13/2022] Open
Abstract
The Repurposing Drugs in Oncology (ReDO) Project seeks to repurpose well-known and well-characterised non-cancer drugs for new uses in oncology. The rationale for this project is presented, examining current issues in oncological drug development, challenges for health systems, and existing and future patient needs. In addition to discussing the advantages of repurposing, the paper also outlines some of the characteristics used in the selection of drug candidates by this project. Challenges in moving candidate drugs into clinical trial and subsequent practice are also discussed.
Collapse
Affiliation(s)
- Pan Pantziarka
- Anticancer Fund, Brussels, 1853 Strombeek-Bever, Belgium ; The George Pantziarka TP53 Trust, London KT1 2JP, UK
| | | | - Lydie Meheus
- Anticancer Fund, Brussels, 1853 Strombeek-Bever, Belgium
| | | | | | - P Vikas
- GlobalCures, Inc, Newton, MA 02459, USA ; Beth Israel Deaconess Medical Centre and Harvard Medical School, Boston, MA 02215, USA
| |
Collapse
|
29
|
Abstract
A mathematical model for cancer chemotherapy of heterogeneous tumor populations is considered as an optimal control problem with the objective to minimize the tumor burden over a prescribed therapy horizon. While an upfront maximum tolerated dose (MTD) regimen with rest-period has been confirmed as mathematically optimal for models when the tumor population is homogeneous, in the presence of partially sensitive or even resistant cells, protocols that administer the therapeutic agents at lower dose rates described by so-called singular controls become a viable alternative. In this paper, the structure of protocols that follow an initial upfront maximum dose treatment with reduced dose rate singular controls is investigated. Such protocols reflect structures which in the medical literature sometimes are called chemo-switch protocols.
Collapse
Affiliation(s)
- URSZULA LEDZEWICZ
- Department of Mathematics and Statistics, Southern Illinois University Edwardsville, Edwardsville, Illinois, 62026-1653, USA
| | - HEINZ SCHÄTTLER
- Department of Electrical and Systems Engineering, Washington University, St. Louis, Missouri, 63130-4899, USA
| |
Collapse
|
30
|
Lien K, Georgsdottir S, Sivanathan L, Chan K, Emmenegger U. Low-dose metronomic chemotherapy: a systematic literature analysis. Eur J Cancer 2013; 49:3387-95. [PMID: 23880474 DOI: 10.1016/j.ejca.2013.06.038] [Citation(s) in RCA: 115] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Accepted: 06/28/2013] [Indexed: 12/21/2022]
Abstract
Low-dose metronomic (LDM) chemotherapy, the frequent and continuous use of low doses of conventional chemotherapeutics, is an emerging alternative to conventional chemotherapy. While promising tumour control rates and excellent safety profiles have been observed, there are no definitive phase III trial results. Furthermore, the selection of patients, drug dosages and dosing intervals is empirical. To systematically review the current state of knowledge regarding LDM chemotherapy, we searched the MEDLINE, EMBASE, CENTRAL and PubMed databases for fully published LDM chemotherapy trials. We calculated the relative dose-intensity (RDI, mg/m(2)/week) of each LDM regimen as compared to conventional maximum tolerated dose (MTD) dosages and the 'dosing-density' (DD, % of days with chemotherapy administration per cycle). Meta-regression was performed to examine factors associated with disease control rate (DCR; complete response (CR)+partial response (PR)+stable disease (SD)). Eighty studies involving mainly pretreated patients with advanced/metastatic breast (26.25%) and prostate (11.25%) cancers were retrieved. The most commonly used drug was cyclophosphamide (43%). LDM chemotherapy was frequently combined with other therapies (64.5%). Response rate (RR) and progression-free survival (PFS) were the most frequent primary end-points (24% and 19%). Mean RR was 26.03% (95% confidence interval (CI): 21.4-30.7), median PFS was 4.6months (interquartile range (IQR): 2.9-7.0) and mean DCR was 56.3% (95% CI: 50.9-61.6). RDI, DD and metronomic drug used were not associated with DCR. Grade 3/4 adverse events were rare (anaemia 7.78%, fatigue 13.4%). Thus, LDM therapy appears to be clinically beneficial and safe in a broad range of tumors. However, meta-regression analysis did not identify predictive factors of response.
Collapse
Affiliation(s)
- K Lien
- Division of Medical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Canada
| | | | | | | | | |
Collapse
|
31
|
Benzekry S, Hahnfeldt P. Maximum tolerated dose versus metronomic scheduling in the treatment of metastatic cancers. J Theor Biol 2013; 335:235-44. [PMID: 23850479 DOI: 10.1016/j.jtbi.2013.06.036] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Revised: 05/15/2013] [Accepted: 06/27/2013] [Indexed: 10/26/2022]
Abstract
Although optimal control theory has been used for the theoretical study of anti-cancerous drugs scheduling optimization, with the aim of reducing the primary tumor volume, the effect on metastases is often ignored. Here, we use a previously published model for metastatic development to define an optimal control problem at the scale of the entire organism of the patient. In silico study of the impact of different scheduling strategies for anti-angiogenic and cytotoxic agents (either in monotherapy or in combination) is performed to compare a low-dose, continuous, metronomic administration scheme with a more classical maximum tolerated dose schedule. Simulation results reveal differences between primary tumor reduction and control of metastases but overall suggest use of the metronomic protocol.
Collapse
Affiliation(s)
- Sébastien Benzekry
- Center of Cancer Systems Biology, Steward Research & Specialty Projects Corp., St Elizabeth's Medical Center, Tufts University School of Medicine, Boston 02135, USA.
| | | |
Collapse
|
32
|
Kandalaft LE, Chiang CL, Tanyi J, Motz G, Balint K, Mick R, Coukos G. A Phase I vaccine trial using dendritic cells pulsed with autologous oxidized lysate for recurrent ovarian cancer. J Transl Med 2013; 11:149. [PMID: 23777306 PMCID: PMC3693890 DOI: 10.1186/1479-5876-11-149] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Accepted: 06/12/2013] [Indexed: 02/04/2023] Open
Abstract
Purpose Ovarian cancer, like most solid tumors, is in dire need of effective therapies. The significance of this trial lies in its promise to spearhead the development of combination immunotherapy and to introduce novel approaches to therapeutic immunomodulation, which could enable otherwise ineffective vaccines to achieve clinical efficacy. Rationale Tumor-infiltrating T cells have been associated with improved outcome in ovarian cancer, suggesting that activation of antitumor immunity will improve survival. However, molecularly defined vaccines have been generally disappointing. Cancer vaccines elicit a modest frequency of low-to-moderate avidity tumor-specific T-cells, but powerful tumor barriers dampen the engraftment, expansion and function of these effector T-cells in the tumor, thus preventing them from reaching their full therapeutic potential. Our work has identified two important barriers in the tumor microenvironment: the blood-tumor barrier, which prevents homing of effector T cells, and T regulatory cells, which inactivate effector T cells. We hypothesize that cancer vaccine therapy will benefit from combinations that attenuate these two barrier mechanisms. Design We propose a three-cohort sequential study to investigate a combinatorial approach of a new dendritic cell (DC) vaccine pulsed with autologous whole tumor oxidized lysate, in combination with antiangiogenesis therapy (bevacizumab) and metronomic cyclophosphamide, which impacts Treg cells. Innovation This study uses a novel autologous tumor vaccine developed with 4-day DCs pulsed with oxidized lysate to elicit antitumor response. Furthermore, the combination of bevacizumab with a whole tumor antigen vaccine has not been tested in the clinic. Finally the combination of bevacizumab and metronomic cyclophosphamide in immunotherapy is novel.
Collapse
Affiliation(s)
- Lana E Kandalaft
- Ovarian Cancer Research Center, University of Pennsylvania, Philadelphia, PA, USA.
| | | | | | | | | | | | | |
Collapse
|
33
|
Briasoulis E, Aravantinos G, Kouvatseas G, Pappas P, Biziota E, Sainis I, Makatsoris T, Varthalitis I, Xanthakis I, Vassias A, Klouvas G, Boukovinas I, Fountzilas G, Syrigos KN, Kalofonos H, Samantas E. Dose selection trial of metronomic oral vinorelbine monotherapy in patients with metastatic cancer: a hellenic cooperative oncology group clinical translational study. BMC Cancer 2013; 13:263. [PMID: 23718900 PMCID: PMC3674943 DOI: 10.1186/1471-2407-13-263] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Accepted: 05/21/2013] [Indexed: 11/23/2022] Open
Abstract
Background Metronomic chemotherapy is considered an anti-angiogenic therapy that involves chronic administration of low-dose chemotherapy at regular short intervals. We investigated the optimal metronomic dose of oral vinorelbine when given as monotherapy in patients with metastatic cancer. Methods Patients with recurrent metastatic breast (BC), prostate (PC) or non-small cell lung cancer (NSCLC) and adequate organ functions were randomly assigned to 30, 40 or 50 mg vinorelbine, taken orally three times a week. Treatment continued until disease progression, unacceptable toxicity, withdrawal of consent or maximum 24 months. Primary endpoint was time-to-treatment failure (TTF) and secondary were progression-free survival (PFS), toxicity, changes in blood concentrations of angiogenesis-associated biomarkers and pharmacokinetics. Results Seventy-three patients were enrolled. Four-month TTF rate did not differ between the three arms: 25.9% (11.1%-46.2% 95% Confidence Interval), 33.3% (15.6%-55.3%) and 18.2% (5.2%-40.3%) for the 30 mg, 40 mg and 50 mg arms (p-value = 0.56). Objective response was seen in 2 patients with NSCLC (treated at 30 and 50 mg respectively), one with BC (at 40 m g) and one with PC (at 50 mg) and lasted from 4 to 100 weeks, with maximum response duration achieved at 50 mg. Adverse events were mild and negligible and did not differ between the three arms. Blood levels of vinorelbine reached steady state from the second week of treatment and mean values for the 30, 40 and 50 mg were respectively 1.8 ng/ml (SD 1.10), 2.2 ng/ml (SD 1.87) and 2.6 ng/ml (SD 0.69). Low pre-treatment blood concentrations of FGF2 and IL8 predicted favorable response to therapy (p values 0.02 and 0.006, respectively), while high levels of TEK gene transcript predicted treatment resistance. Conclusions Considering the antitumor activity and response duration, the negligible toxicity of the highest dose investigated and the lack of drug accumulation over time, we suggest that 50 mg given three times a week is the optimal dose for metronomic oral vinorelbine. Further investigation of metronomic oral vinorelbine (MOVIN) at this dose is warranted in combination with conventional chemotherapy regimens and targeted therapies. Trial registration Clinicaltrials.gov NCT00278070
Collapse
|
34
|
Hahnfeldt P, Hlatky L, Klement GL. Center of cancer systems biology second annual workshop--tumor metronomics: timing and dose level dynamics. Cancer Res 2013; 73:2949-54. [PMID: 23492368 DOI: 10.1158/0008-5472.can-12-3807] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Metronomic chemotherapy, the delivery of doses in a low, regular manner so as to avoid toxic side effects, was introduced over 12 years ago in the face of substantial clinical and preclinical evidence supporting its tumor-suppressive capability. It constituted a marked departure from the classic maximum-tolerated dose (MTD) strategy, which, given its goal of rapid eradication, uses dosing sufficiently intense to require rest periods between cycles to limit toxicity. Even so, upfront tumor eradication is frequently not achieved with MTD, whereupon a de facto goal of longer-term tumor control is often pursued. As metronomic dosing has shown tumor control capability, even for cancers that have become resistant to the same drug delivered under MTD, the question arises whether it may be a preferable alternative dosing approach from the outset. To date, however, our knowledge of the coupled dynamics underlying metronomic dosing is neither sufficiently well developed nor widely enough disseminated to establish its actual potential. Meeting organizers thus felt the time was right, armed with new quantitative approaches, to call a workshop on "Tumor Metronomics: Timing and Dose Level Dynamics" to explore prospects for gaining a deeper, systems-level appreciation of the metronomics concept. The workshop proved to be a forum in which experts from the clinical, biologic, mathematical, and computational realms could work together to clarify the principles and underpinnings of metronomics. Among other things, the need for significant shifts in thinking regarding endpoints to be used as clinical standards of therapeutic progress was recognized.
Collapse
Affiliation(s)
- Philip Hahnfeldt
- Center of Cancer Systems Biology, Steward St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, MA, USA.
| | | | | |
Collapse
|
35
|
Faivre C, Barbolosi D, Pasquier E, André N. A mathematical model for the administration of temozolomide: comparative analysis of conventional and metronomic chemotherapy regimens. Cancer Chemother Pharmacol 2013; 71:1013-9. [DOI: 10.1007/s00280-013-2095-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Accepted: 01/14/2013] [Indexed: 02/08/2023]
|
36
|
Billy F, Clairambault J. Designing proliferating cell population models with functional targets for control by anti-cancer drugs. ACTA ACUST UNITED AC 2013. [DOI: 10.3934/dcdsb.2013.18.865] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
37
|
Almog N. Genes and regulatory pathways involved in persistence of dormant micro-tumors. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2013; 734:3-17. [PMID: 23143972 DOI: 10.1007/978-1-4614-1445-2_1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Micro-tumors can remain dormant for prolonged periods of time before they switch and enter the rapid growth phase. This initial stage in tumor progression is clearly understudied. In spite of high prevalence, significant clinical implications and increased interest by the research community, tumor dormancy is still poorly understood. The topic of tumor dormancy also suffers from a lack of definition and an agreed upon terminology to describe it. Additionally, the number of reproducible experimental models available for studying indolence of human micro-tumors is quite limited. Here, we describe the development of a general class of in vivo models of indolent human tumors and how these models can be used to elucidate molecular and cellular mechanisms involved in the regulation of dormancy. The models consist of human tumor cell lines that form microscopic cancerous lesions in mice. Although these lesions contain viable and fully malignant cancer cells, the tumors do not expand in size but remain occult for prolonged periods until they eventually spontaneously switch and become fast-growing tumors. Consistent with Judah Folkman's vision that tumors will remain occult and microscopic until they acquire the ability to recruit new and functional blood vessels, the dormancy period of the micro-tumors is associated with impaired angiogenic capacity. Such models can be used for dissecting the host and the tumor-derived regulatory mechanisms of tumor dormancy. Understanding the process by which dormant tumors can overcome growth constraints and emerge from dormancy, resuming size expansion, may provide insights into novel strategies to prolong the dormancy state or to block tumor formation in the early stages, before they are physically detected or become symptomatic.
Collapse
Affiliation(s)
- Nava Almog
- Tufts University School of Medicine, Boston, MA 02135, USA.
| |
Collapse
|
38
|
Nars MS, Kaneno R. Immunomodulatory effects of low dose chemotherapy and perspectives of its combination with immunotherapy. Int J Cancer 2012; 132:2471-8. [PMID: 22927096 DOI: 10.1002/ijc.27801] [Citation(s) in RCA: 89] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Revised: 06/29/2012] [Accepted: 08/16/2012] [Indexed: 02/06/2023]
Abstract
Given that cancer is one of the main causes of death worldwide, many efforts have been directed toward discovering new treatments and approaches to cure or control this group of diseases. Chemotherapy is the main treatment for cancer; however, a conventional schedule based on maximum tolerated dose (MTD) shows several side effects and frequently allows the development of drug resistance. On the other side, low dose chemotherapy involves antiangiogenic and immunomodulatory processes that help host to fight against tumor cells, with lower grade of side effects. In this review, we present evidence that metronomic chemotherapy, based on the frequent administration of low or intermediate doses of chemotherapeutics, can be better than or as efficient as MTD. Finally, we present some data indicating that noncytotoxic concentrations of antineoplastic agents are able to both up-regulate the immune system and increase the susceptibility of tumor cells to cytotoxic T lymphocytes. Taken together, data from the literature provides us with sufficient evidence that low concentrations of selected chemotherapeutic agents, rather than conventional high doses, should be evaluated in combination with immunotherapy.
Collapse
Affiliation(s)
- Mariana S Nars
- Department of Microbiology and Immunology, Institute of Biosciences, UNESP-Univ Estadual Paulista, Botucatu, São Paulo, Brazil
| | | |
Collapse
|
39
|
Yokoi T, Tamaki T, Shimizu T, Nomura S. A pilot study of a metronomic chemotherapy regimen with weekly low-dose docetaxel for previously treated non-small cell lung cancer. LUNG CANCER-TARGETS AND THERAPY 2012; 3:15-20. [PMID: 28210121 DOI: 10.2147/lctt.s30937] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Low-dose metronomic (LDM) chemotherapy is a novel approach that involves frequent administration of a low dose of chemotherapeutic agent without a long interval. PURPOSE The aim of this clinical pilot study was to evaluate the toxicity and efficacy of LDM chemotherapy with weekly low-dose docetaxel for previously treated non-small cell lung cancer (NSCLC). PATIENTS AND METHODS The enrolled patients received 15 mg/m2 of docetaxel intravenously on a weekly basis without any interval. RESULTS Twenty-seven patients were enrolled in the study; 20 were men, and seven were women. The median age was 62 years (range: 32-75). Eleven patients were stage IIIB, and 16 were stage IV. The Eastern Cooperative Oncology Group performance status was 0 or 1. There was no severe hematological adverse effect; importantly, there was no neutropenia or thrombocytopenia. The objective response rate was 7.4% and the disease control rate was 51.9%. The median survival time was 16.4 months (95% CI: 5.7-36.4). CONCLUSION Our preliminary results indicate that our metronomic regimen was well tolerated and active in patients with previously treated NSCLC. Thus, further investigation of this LDM regimen is warranted.
Collapse
Affiliation(s)
- Takashi Yokoi
- First Department of Internal Medicine, Kansai Medical University, Moriguchi City, Osaka, Japan
| | - Takeshi Tamaki
- First Department of Internal Medicine, Kansai Medical University, Moriguchi City, Osaka, Japan
| | - Toshiki Shimizu
- First Department of Internal Medicine, Kansai Medical University, Moriguchi City, Osaka, Japan
| | - Shosaku Nomura
- First Department of Internal Medicine, Kansai Medical University, Moriguchi City, Osaka, Japan
| |
Collapse
|
40
|
|
41
|
Affiliation(s)
- Andrew S Chi
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | | |
Collapse
|
42
|
Abstract
Analytical modeling and computer simulation may provide an assessment for the success of different cancer therapeutic strategies (both maximum tolerable dosing and metronomic dosing), particularly for the presence of microscopically dormant cells. Different authors substantially showed that metronomic strategy is better than maximum tolerable dosing. In the present work, the different physiological constraints have been considered. Accumulation of drug, dead tumor cells as well as metabolites produced by living tumor cells produce toxicity that affect the physiological system. This affects the subsequent drug application and thereby the therapeutic procedure and its outcome. Translating these into logistics and incorporating them into analytical state-space models, the transformation of the overall system has been examined through computer simulations. The observation is that situations of frequent drug stoppages may occur due to patho-physiological constraints, which may in turn inactivate the cell-mediated immune response. Simulation results suggest that even the combination of different strategies does not improve the situation. Other ways of boosting the immunity and tuning of biological constraints would be required to get positive outcome.
Collapse
Affiliation(s)
- DURJOY MAJUMDER
- Computer Science and Technology Department, Bengal Engineering and Science University, Shibpur, P.O. Botanic Garden, Howrah 711103, West Bengal, India
| | - ABHIK MUKHERJEE
- Computer Science and Technology Department, Bengal Engineering and Science University, Shibpur, P.O. Botanic Garden, Howrah 711103, West Bengal, India
| |
Collapse
|
43
|
MUKHERJEE ABHIK, MAJUMDER DURJOY, ICBAL ASIF. EXPLORING THE EFFECTIVENESS OF LOW CONTINUOUS CHEMO-BIO-THERAPEUTIC TREATMENT OF CANCER THROUGH ANALYTICAL SYSTEM MODELLING. J BIOL SYST 2011. [DOI: 10.1142/s0218339006001696] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Analytical models of tumor growth in the presence and absence of drug is important for studying the dynamics of treatment in oncology. In this paper, a time-variant state-space model is investigated. The model captures the inherent nonlinearity of the system. Physiological constraints of the system are considered in the model and controllability of the tumor load is examined. If it is possible to find a sequence of drug doses that can drive the tumor load to any arbitrary negligibly small final condition from any arbitrary initial condition in a given number of days without affecting the physiological state of the patient, the tumor is said to be controllable. Drug administration strategies like maximum tolerated dose, metronomic chemotherapy in the presence and absence of immunotherapy have been examined. It is found that low yet prolonged continuous dosing of drug along with tuning of biological factors may be a better workable strategy for positive treatment outcome.
Collapse
Affiliation(s)
- ABHIK MUKHERJEE
- Computer Science and Technology Department, Bengal Engineering and Science University, Shibpur, P.O. Botanic Garden, Howrah-711103, West Bengal, India
| | - DURJOY MAJUMDER
- 103, Bangur Avenue, Block- "C", Kolkata-700055, West Bengal, India
| | - ASIF ICBAL
- Department of Electrical Engineering, Durgapur Institute of Advanced Technology and Management, Rajbandh, Durgapur-713212, West Bengal, India
| |
Collapse
|
44
|
Leach TN, Childress MO, Greene SN, Mohamed AS, Moore GE, Schrempp DR, Lahrman SR, Knapp DW. Prospective trial of metronomic chlorambucil chemotherapy in dogs with naturally occurring cancer. Vet Comp Oncol 2011; 10:102-12. [DOI: 10.1111/j.1476-5829.2011.00280.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
|
45
|
Soriano JL, Batista N, Santiesteban E, Lima M, González J, García R, Zarza Y, López MV, Rodríguez M, Loys JL, Montejo N, Aguirre F, Macías A, Vázquez AM. Metronomic Cyclophosphamide and Methotrexate Chemotherapy Combined with 1E10 Anti-Idiotype Vaccine in Metastatic Breast Cancer. Int J Breast Cancer 2011; 2011:710292. [PMID: 22295231 PMCID: PMC3262579 DOI: 10.4061/2011/710292] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2010] [Revised: 04/24/2011] [Accepted: 05/09/2011] [Indexed: 02/01/2023] Open
Abstract
The use of low doses of cytotoxic agents continuously for prolonged periods is an alternative for the treatment of patients with metastatic breast cancer who have developed resistance to conventional chemotherapy. The combination of metronomic chemotherapy with therapeutic vaccines might increase the efficacy of the treatment. Twenty one patients with metastatic breast cancer in progression and a Karnosky index ≥60%, were treated with metronomic chemotherapy (50 mg of cyclophospamide orally daily and 2.5 mg of methotrexate orally bi-daily), in combination with five bi-weekly subcutaneous injections of 1 mg of aluminum hydroxide-precipitated 1E10 anti-idiotype MAb (1E10-Alum), followed by reimmunizations every 28 days. Five patients achieved objective response, eight showed stable disease and eight had disease progression. Median time to progression was 9,8 months, while median overall survival time was 12,93 months. The median duration of the response (CR+PR+SD) was 18,43 months (12,20–24,10 months), being higher than 12 months in 76,9% of the patients. Overall toxicity was generally mild. Metronomic chemotherapy combined with 1E10-Alum vaccine immunotherapy might be a useful therapeutic option for the treatment of metastatic breast cancer due to its potential impact on survival and patient quality of live, low toxicity and advantages of the administration.
Collapse
Affiliation(s)
- Jorge L Soriano
- Oncology Service, Hermanos Amejeiras Hospital, Havana 10300, Cuba
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
46
|
d'Onofrio A, Gandolfi A. Resistance to antitumor chemotherapy due to bounded-noise-induced transitions. PHYSICAL REVIEW. E, STATISTICAL, NONLINEAR, AND SOFT MATTER PHYSICS 2010; 82:061901. [PMID: 21230684 DOI: 10.1103/physreve.82.061901] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2010] [Revised: 10/20/2010] [Indexed: 05/30/2023]
Abstract
Tumor angiogenesis is a landmark of solid tumor development, but it is also directly relevant to chemotherapy. Indeed, the density and quality of neovessels may influence the effectiveness of therapies based on blood-born agents. In this paper, first we define a deterministic model of antiproliferative chemotherapy in which the drug efficacy is a unimodal function of vessel density, and then we show that under constant continuous infusion therapy the tumor-vessel system may be multistable. However, the actual drug concentration profiles are affected by bounded even if possibly large fluctuations. Through numerical simulations, we show that the tumor volume may undergo transitions to the higher equilibrium value induced by the bounded noise. In case of periodically delivered boli-based chemotherapy, we model the fluctuations due to time variability of both the drug clearance rate and the distribution volume, as well as those due to irregularities in drug delivery. We observed noise-induced transitions also in case of periodic delivering. By applying a time dense scheduling with constant average delivered drug (metronomic scheduling), we observed an easier suppression of the transitions. Finally, we propose to interpret the above phenomena as an unexpected non-genetic kind of resistance to chemotherapy.
Collapse
Affiliation(s)
- Alberto d'Onofrio
- Department of Experimental Oncology, European Institute of Oncology, Via Ripamonti 435, I20141 Milano, Italy.
| | | |
Collapse
|
47
|
Mukherjee A, Majumder D. Dynamical model for assessment of anti-angiogenic therapy of cancer. MOLECULAR BIOSYSTEMS 2010; 6:1047-55. [PMID: 20358121 DOI: 10.1039/b917545h] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Different experimental models have substantially established that the anti-angiogenic (AAG)group of drugs are able to control the growth of tumor mass by cutting down the nutritive supply to the cancer cells. The mechanism of action of this group of drugs acts on the cells of the vascular endothelium. Recently, different AAG drugs have been in clinical trials. Initial clinical trials showed that application of AAG drugs produced different sorts of toxicity in patients,so calibration of the doses and drug application schedules are very important at present.Hence, development of analytical models would definitely help in this respect, particularly atthe individual level. The analytical model presented here may help to make a judicious choice of drug doses and drug schedule to control the growth of the tumor system under the condition of malignancy.
Collapse
Affiliation(s)
- Abhik Mukherjee
- Department of Computer Science & Technology, Bengal Engineering & Science University, Shibpur, Botanic Garden, Howrah 711103, West Bengal, India
| | | |
Collapse
|
48
|
Chan HH, Chu TH, Chien HF, Sun CK, Wang EM, Pan HB, Kuo HM, Hu TH, Lai KH, Cheng JT, Tai MH. Rapid induction of orthotopic hepatocellular carcinoma in immune-competent rats by non-invasive ultrasound-guided cells implantation. BMC Gastroenterol 2010; 10:83. [PMID: 20649994 PMCID: PMC2918526 DOI: 10.1186/1471-230x-10-83] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2010] [Accepted: 07/22/2010] [Indexed: 11/25/2022] Open
Abstract
Background The fact that prognoses remain poor in patients with advanced hepatocellular carcinoma highlights the demand for suitable animal models to facilitate the development of anti-cancer medications. This study employed a relatively non-invasive approach to establish an orthotopic hepatocellular carcinoma model in immune-competent rats. This was done by ultrasound-guided implantation of cancer cells and the model was used to evaluate the therapeutic efficacy of short-term and low-dose epirubicin chemotherapy. Methods Rat Novikoff hepatoma cells were injected percutaneously into the liver lobes of Sprague-Dawley rats under the guidance of high resolution ultrasound. The implantation rate and the correlation between dissected and ultrasound-measured tumor sizes were evaluated. A similar induction procedure was performed by means of laparotomy in a different group of rats. Pairs of tumor measurement were compared by ultrasound and computerized tomography scan. Rats with a successful establishment of the tumor were divided into the treatment (7-day low-dose epirubicin) group and the control group. The tumor sizes were non-invasively monitored by the same ultrasound machine. Blood and tumor tissues from tumor-bearing rats were examined by biochemical and histological analysis respectively. Results Ultrasound-guided implantation of Novikoff hepatoma cells led to the formation of orthotopic hepatocellular carcinoma in 60.4% (55/91) of the Sprague-Dawley rats. Moreover, tumor sizes measured by ultrasound significantly correlated with those measured by calipers after sacrificing the animals (P < 0.00001). The rate of tumor induction by ultrasound-guided implantation was comparable to that of laparotomy (55/91, 60.4% vs. 39/52, 75%) and no significant difference in sizes of tumor was noted between the two groups. There was a significant correlation in tumor size measurement by ultrasound and computerized tomography scan. In tumor-bearing rats, short-term and low-dose epirubicin chemotherapy caused a significant reduction in tumor growth, and was found to be associated with enhanced apoptosis and attenuated proliferation as well as a decrease in the microvessel density in tumors. Conclusions Ultrasound-guided implantation of Novikoff hepatoma cells is an effective means of establishing orthotopic hepatocellular carcinoma in Sprague-Dawley rats. Short-term and low-dose epirubicin chemotherapy had perturbed tumor progression by inducing apoptosis and neovascularization blockade.
Collapse
Affiliation(s)
- Hoi-Hung Chan
- Department of Biological Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
49
|
La chimiothérapie métronomique du cancer du sein métastatique: à propos d’un cas. ONCOLOGIE 2010. [DOI: 10.1007/s10269-010-1912-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
50
|
Semenza GL. Defining the role of hypoxia-inducible factor 1 in cancer biology and therapeutics. Oncogene 2010; 29:625-34. [PMID: 19946328 PMCID: PMC2969168 DOI: 10.1038/onc.2009.441] [Citation(s) in RCA: 1310] [Impact Index Per Article: 93.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2009] [Revised: 09/02/2009] [Accepted: 09/26/2009] [Indexed: 02/06/2023]
Abstract
Adaptation of cancer cells to their microenvironment is an important driving force in the clonal selection that leads to invasive and metastatic disease. O2 concentrations are markedly reduced in many human cancers compared with normal tissue, and a major mechanism mediating adaptive responses to reduced O2 availability (hypoxia) is the regulation of transcription by hypoxia-inducible factor 1 (HIF-1). This review summarizes the current state of knowledge regarding the molecular mechanisms by which HIF-1 contributes to cancer progression, focusing on (1) clinical data associating increased HIF-1 levels with patient mortality; (2) preclinical data linking HIF-1 activity with tumor growth; (3) molecular data linking specific HIF-1 target gene products to critical aspects of cancer biology and (4) pharmacological data showing anticancer effects of HIF-1 inhibitors in mouse models of human cancer.
Collapse
Affiliation(s)
- G L Semenza
- Vascular Program, Institute for Cell Engineering, The Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.
| |
Collapse
|