On the Dynamics of Tumor-Immune System Interactions and Combined Chemo- and Immunotherapy

Exploring trade-offs in drug administration for cancer treatment: A multi-criteria optimisation approach

This study addresses the combination of immunotherapy and chemotherapy in cancer treatment, recognising its promising effectiveness but highlighting the challenges of complex interactions between these therapeutic modalities. The central objective is to determine guidelines for the optimal administration of drugs, using an optimal control model that considers interactions in tumour dynamics, including cancer cells, the immune system, and therapeutic agents. The optimal control model is transformed into a multi-objective optimisation problem with treatment constraints. This is achieved by introducing adjustable trade-offs, allowing personalised adaptations in drug administration to achieve an optimal balance between established objectives. Various optimisation problems are addressed, considering two and three simultaneous objectives, such as optimising the number of cancer cells and the density of effector cells at the final treatment time. The diverse combinations presented reflect the model's flexibility in the face of multi-objective optimisation, providing a range of approaches to meet specific medical needs. The analysis of Pareto optimal fronts in in silico investigation offers an additional resource for decision-makers, enabling a more effective determination of the optimal administration of cytotoxic and immunotherapeutic agents. By leveraging an optimal control model, we have demonstrated the effectiveness of considering interactions in tumour dynamics, including the integration of immunotherapy and chemotherapy. Our findings underscore the importance of tailored treatment plans to achieve optimal outcomes, showcasing the versatility of our approach in addressing individual patient needs. The insights gained from our analysis offer valuable guidance for future research and clinical practice, paving the way for more effective and personalised cancer therapies.

Overcoming Channel Uncertainties in Touchable Molecular Communication for Direct-Drug-Targeting-Assisted Immuno-Chemotherapy

OBJECTIVE

The performance of targeted immuno-chemotherapy of tumor is highly exposed to drug absorption in systemic circulation, which reduces its efficiency and increases side-effects. Direct drug targeting (DDT) combined with immuno-chemotherapy has the potential to mitigate the undesired systemic exposure, by using drug-loaded nanorobots to target cancer cells with the shortest possible physiological routes. This process can be modeled by the "touchable" (i.e., externally controllable and trackable) molecular communication system. However, such a complex process still suffers from various pharmacokinetic uncertainties caused by diffusion, degeneration, and branching of nanorobots (DDT pharmacokinetic uncertainties), as well as tumor/immune system modeling errors. The current work aims at identifying optimal drug administration plans by overcoming such challenges.

METHODS

A revisited tumor-immune interaction model is proposed to incorporate randomness of the drug concentration in the tumor site. Then, a robust multiple model predictive control (MMPC) scheme for the proposed tumor-immune interaction model is designed that uses multiple system models and an adaptive switch to identify the optimal plans for mixed drug administration via drug-loaded nanorobots. Furthermore, a wide range of prediction horizons under different loss scenarios of drug-loaded nanorobots and system model mismatches have been investigated in order to identify safe operating regions. From the molecular communications paradigm, this can be considered as a more robust information transmission system with feedback of channel state information to the transmitter implemented in the control unit.

RESULTS

The efficacy of the proposed MMPC is illustrated through identification of globally optimized drug administration schedules subject to various controller operation imperfections, which lead to successful cancer treatment as demonstrated through computational experiments.

CONCLUSION

By combining DDT with conventional mixed immunotherapy and chemotherapy, the proposed robust MMPC offers promising performance in controlling tumor growth while keeping the immune cell density higher than a specific level in the presence of both DDT pharmacokinetic uncertainties and system model mismatches.

SIGNIFICANCE

We believe that the proposed design framework represents an important first step towards clinically relevant DDT in the combined immunotherapy and chemotherapy of tumor given its robust performance.

Overcoming Channel Uncertainties in Molecular-Communication-Inspired Direct Drug Targeting

Recent progress in the development of new methods for cancer treatment has shown advantages of multiple therapies over mono-therapy. In particular, direct drug targeting (DDT) combined with mixed immunotherapy and chemotherapy has the potential to mitigate the undesired side-effects allied with conventional therapies, where nanorobots in DDT carry therapeutic agents through the blood vessel channel in order to localize and target diseased tissue with a safe drug interaction. This process can be modeled by a "touchable" (i.e., externally controllable and trackable) molecular communication (MC) system. However, in such a complex process overcoming unavoidable vascular channel uncertainties remains a great challenge. In this paper a multiple model predictive controller (MMPC) is proposed, which is robust against random channel uncertainties. The efficacy of the proposed method is illustrated through identification of globally optimized drug administration schedules. Furthermore, we introduce upper and lower bounds on the inputs and outputs which lead to clinically realistic constraints on the system. Simulation results demonstrate the promising performance of proposed MMPC to control tumor growth in presence of vascular channel uncertainties in MC-inspired DDT for cancer treatment.

Mathematical analysis of a tumour-immune interaction model: A moving boundary problem

A spatio-temporal mathematical model, in the form of a moving boundary problem, to explain cancer dormancy is developed. Analysis of the model is carried out for both temporal and spatio-temporal cases. Stability analysis and numerical simulations of the temporal model replicate experimental observations of immune-induced tumour dormancy. Travelling wave solutions of the spatio-temporal model are determined using the hyperbolic tangent method and minimum wave speeds of invasion are calculated. Travelling wave analysis depicts that cell invasion dynamics are mainly driven by their motion and growth rates. A stability analysis of the spatio-temporal model shows a possibility of dynamical stabilization of the tumour-free steady state. Simulation results reveal that the tumour swells to a dormant level.

Therapeutic Potential of Bacteria against Solid Tumors

Intentional bacterial infections can produce efficacious antitumor responses in mice, rats, dogs, and humans. However, low overall success rates and intense side effects prevent such approaches from being employed clinically. In this work, we titered bacteria and/or the proinflammatory cytokine TNFα in a set of established murine models of cancer. To interpret the experiments conducted, we considered and calibrated a tumor-effector cell recruitment model under the influence of functional tumor-associated vasculature. In this model, bacterial infections and TNFα enhanced immune activity and altered vascularization in the tumor bed. Information to predict bacterial therapy outcomes was provided by pretreatment tumor size and the underlying immune recruitment dynamics. Notably, increasing bacterial loads did not necessarily produce better long-term tumor control, suggesting that tumor sizes affected optimal bacterial loads. Short-term treatment responses were favored by high concentrations of effector cells postinjection, such as induced by higher bacterial loads, but in the longer term did not correlate with an effective restoration of immune surveillance. Overall, our findings suggested that a combination of intermediate bacterial loads with low levels TNFα administration could enable more favorable outcomes elicited by bacterial infections in tumor-bearing subjects. Cancer Res; 77(7); 1553-63. ©2017 AACR.

Cancer therapeutic potential of combinatorial immuno- and vasomodulatory interventions

Currently, most of the basic mechanisms governing tumour-immune system interactions, in combination with modulations of tumour-associated vasculature, are far from being completely understood. Here, we propose a mathematical model of vascularized tumour growth, where the main novelty is the modelling of the interplay between functional tumour vasculature and effector cell recruitment dynamics. Parameters are calibrated on the basis of different in vivo immunocompromised Rag1(-/-) and wild-type (WT) BALB/c murine tumour growth experiments. The model analysis supports that tumour vasculature normalization can be a plausible and effective strategy to treat cancer when combined with appropriate immunostimulations. We find that improved levels of functional tumour vasculature, potentially mediated by normalization or stress alleviation strategies, can provide beneficial outcomes in terms of tumour burden reduction and growth control. Normalization of tumour blood vessels opens a therapeutic window of opportunity to augment the antitumour immune responses, as well as to reduce intratumoral immunosuppression and induced hypoxia due to vascular abnormalities. The potential success of normalizing tumour-associated vasculature closely depends on the effector cell recruitment dynamics and tumour sizes. Furthermore, an arbitrary increase in the initial effector cell concentration does not necessarily imply better tumour control. We evidence the existence of an optimal concentration range of effector cells for tumour shrinkage. Based on these findings, we suggest a theory-driven therapeutic proposal that optimally combines immuno- and vasomodulatory interventions.

In silico tumor control induced via alternating immunostimulating and immunosuppressive phases

Despite recent advances in the field of Oncoimmunology, the success potential of immunomodulatory therapies against cancer remains to be elucidated. One of the reasons is the lack of understanding on the complex interplay between tumor growth dynamics and the associated immune system responses. Toward this goal, we consider a mathematical model of vascularized tumor growth and the corresponding effector cell recruitment dynamics. Bifurcation analysis allows for the exploration of model's dynamic behavior and the determination of these parameter regimes that result in immune-mediated tumor control. In this work, we focus on a particular tumor evasion regime that involves tumor and effector cell concentration oscillations of slowly increasing and decreasing amplitude, respectively. Considering a temporal multiscale analysis, we derive an analytically tractable mapping of model solutions onto a weakly negatively damped harmonic oscillator. Based on our analysis, we propose a theory-driven intervention strategy involving immunostimulating and immunosuppressive phases to induce long-term tumor control.