| Publications of Eduardo D. Sontag jointly with I. Kareva |
| Articles in journal or book chapters |
| Cancer therapies often fail when intolerable toxicity or drug-resistant cancer cells undermine otherwise effective treatment strategies. Over the past decade, adaptive therapy has emerged as a promising approach to postpone emergence of resistance by altering dose timing based on tumor burden thresholds. Despite encouraging results, these protocols often overlook the crucial role of toxicity-induced treatment breaks, which may permit tumor regrowth. Herein, we explore the following question: would toxicity feedback improve or hinder the efficacy of adaptive therapy? To address this question, we propose a mathematical framework for incorporating toxic feedback into treatment design. We find that the degree of competition between sensitive and resistant populations, along with the growth rate of resistant cells, critically modulates the impact of toxicity feedback on time to progression. Further, our model identifies circumstances where strategic treatment breaks, which may be based on either tumor size or toxicity, can mitigate overtreatment and extend time to progression, both at the baseline parameterization and across a heterogeneous virtual population. Taken together, these findings highlight the importance of integrating toxicity considerations into the design of adaptive therapy. |
| Bispecific T Cell Engagers (BTC) constitute an exciting antibody design in immuno-oncology that acts to bypass antigen presentation and forms a direct link between cancer and immune cells in the tumor microenvironment (TME). By design, BTCs are efficacious only when the drug is bound to both immune and cancer cell targets, and therefore approaches to maximize drug-target trimer in the TME should maximize the drug's efficacy. In this study, we quantitatively investigate how the concentration of ternary complex and its distribution depend on both the targets' specific properties and the design characteristics of the BTC, and specifically on the binding kinetics of the drug to its targets. A simplified mathematical model of drug-target interactions is considered here, with insights from the "three-body" problem applied to the model. Parameter identifiability analysis performed on the model demonstrates that steady-state data, which is often available at the early pre-clinical stages, is sufficient to estimate the binding affinity of the BTC molecule to both targets. The model is used to analyze several existing antibodies that are either clinically approved or are under development, and to explore the common kinetic features. We conclude with a discussion of the limitations of the BTCs, such as the increased likelihood of cytokine release syndrome, and an assessment for a full quantitative pharmacology model that accounts for drug distribution into the peripheral compartment. |
| Metronomic chemotherapy can drastically enhance immunogenic tumor cell death. However, the responsible mechanisms are still incompletely understood. Here, we develop a mathematical model to elucidate the underlying complex interactions between tumor growth, immune system activation, and therapy-mediated immunogenic cell death. Our model is conceptually simple, yet it provides a surprisingly excellent fit to empirical data obtained from a GL261 mouse glioma model treated with cyclophosphamide on a metronomic schedule. The model includes terms representing immune recruitment as well as the emergence of drug resistance during prolonged metronomic treatments. Strikingly, a fixed set of parameters, not adjusted for individuals nor for drug schedule, excellently recapitulates experimental data across various drug regimens, including treatments administered at intervals ranging from 6 to 12 days. Additionally, the model predicts peak immune activation times, rediscovering experimental data that had not been used in parameter fitting or in model construction. The validated model was then used to make predictions about expected tumor-immune dynamics for novel drug administration schedules. Notably, the validated model suggests that immunostimulatory and immunosuppressive intermediates are responsible for the observed phenomena of resistance and immune cell recruitment, and thus for variation of responses with respect to different schedules of drug administration. |
| Internal reports |
| Metronomic chemotherapy can drastically enhance immunogenic tumor cell death. However, the responsible mechanisms are still incompletely understood. Here, we develop a mathematical model to elucidate the underlying complex interactions between tumor growth, immune system activation, and therapy-mediated immunogenic cell death. Our model is conceptually simple, yet it provides a surprisingly excellent fit to empirical data obtained from a GL261 mouse glioma model treated with cyclophosphamide on a metronomic schedule. The model includes terms representing immune recruitment as well as the emergence of drug resistance during prolonged metronomic treatments. Strikingly, a fixed set of parameters, not adjusted for individuals nor for drug schedule, excellently recapitulates experimental data across various drug regimens, including treatments administered at intervals ranging from 6 to 12 days. Additionally, the model predicts peak immune activation times, rediscovering experimental data that had not been used in parameter fitting or in model construction. The validated model was then used to make predictions about expected tumor-immune dynamics for novel drug administration schedules. Notably, the validated model suggests that immunostimulatory and immunosuppressive intermediates are responsible for the observed phenomena of resistance and immune cell recruitment, and thus for variation of responses with respect to different schedules of drug administration. |
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