Selection, calibration, and validation of models of tumor growth

Model discovery approach enables noninvasive measurement of intra-tumoral fluid transport in dynamic MRI

Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) is a routine method to noninvasively quantify perfusion dynamics in tissues. The standard practice for analyzing DCE-MRI data is to fit an ordinary differential equation to each voxel. Recent advances in data science provide an opportunity to move beyond existing methods to obtain more accurate measurements of fluid properties. Here, we developed a localized convolutional function regression that enables simultaneous measurement of interstitial fluid velocity, diffusion, and perfusion in 3D. We validated the method computationally and experimentally, demonstrating accurate measurement of fluid dynamics in situ and in vivo. Applying the method to human MRIs, we observed tissue-specific differences in fluid dynamics, with an increased fluid velocity in breast cancer as compared to brain cancer. Overall, our method represents an improved strategy for studying interstitial flows and interstitial transport in tumors and patients. We expect that our method will contribute to the better understanding of cancer progression and therapeutic response.

A calibration and uncertainty quantification analysis of classical, fractional and multiscale logistic models of tumour growth

BACKGROUND AND OBJECTIVE

The validation of mathematical models of tumour growth is frequently hampered by the lack of sufficient experimental data, resulting in qualitative rather than quantitative studies. Recent approaches to this problem have attempted to extract information about tumour growth by integrating multiscale experimental measurements, such as longitudinal cell counts and gene expression data. In the present study, we investigated the performance of several mathematical models of tumour growth, including classical logistic, fractional and novel multiscale models, in terms of quantifying in-vitro tumour growth in the presence and absence of therapy. We further examined the effect of genes associated with changes in chemosensitivity in cell death rates.

METHODS

The multiscale expansion of logistic growth models was performed by coupling gene expression profiles to the cell death rates. State-of-the-art Bayesian inference, likelihood maximisation and uncertainty quantification techniques allowed a thorough evaluation of model performance.

RESULTS

The results suggest that the classical single-cell population model (SCPM) was the best fit for the untreated and low-dose treatment conditions, while the multiscale model with a cell death rate symmetric with the expression profile of OCT4 (Sym-SCPM) yielded the best fit for the high-dose treatment data. Further identifiability analysis showed that the multiscale model was both structurally and practically identifiable under the condition of known OCT4 expression profiles.

CONCLUSIONS

Overall, the present study demonstrates that model performance can be improved by incorporating multiscale measurements of tumour growth when high-dose treatment is involved.

Model discovery approach enables non-invasive measurement of intra-tumoral fluid transport in dynamic MRI

Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) is a routine method to non-invasively quantify perfusion dynamics in tissues. The standard practice for analyzing DCE-MRI data is to fit an ordinary differential equation to each voxel. Recent advances in data science provide an opportunity to move beyond existing methods to obtain more accurate measurements of fluid properties. Here, we developed a localized convolutional function regression that enables simultaneous measurement of interstitial fluid velocity, diffusion, and perfusion in 3D. We validated the method computationally and experimentally, demonstrating accurate measurement of fluid dynamics in situ and in vivo. Applying the method to human MRIs, we observed tissue-specific differences in fluid dynamics, with an increased fluid velocity in breast cancer as compared to brain cancer. Overall, our method represents an improved strategy for studying interstitial flows and interstitial transport in tumors and patients. We expect that it will contribute to the better understanding of cancer progression and therapeutic response.

Predicting response to combination evofosfamide and immunotherapy under hypoxic conditions in murine models of colon cancer

The goal of this study is to develop a mathematical model that captures the interaction between evofosfamide, immunotherapy, and the hypoxic landscape of the tumor in the treatment of tumors. Recently, we showed that evofosfamide, a hypoxia-activated prodrug, can synergistically improve treatment outcomes when combined with immunotherapy, while evofosfamide alone showed no effects in an in vivo syngeneic model of colorectal cancer. However, the mechanisms behind the interaction between the tumor microenvironment in the context of oxygenation (hypoxic, normoxic), immunotherapy, and tumor cells are not fully understood. To begin to understand this issue, we develop a system of ordinary differential equations to simulate the growth and decline of tumors and their vascularization (oxygenation) in response to treatment with evofosfamide and immunotherapy (6 combinations of scenarios). The model is calibrated to data from in vivo experiments on mice implanted with colon adenocarcinoma cells and longitudinally imaged with [18F]-fluoromisonidazole ([18F]FMISO) positron emission tomography (PET) to quantify hypoxia. The results show that evofosfamide is able to rescue the immune response and sensitize hypoxic tumors to immunotherapy. In the hypoxic scenario, evofosfamide reduces tumor burden by $ 45.07 \pm 2.55 $%, compared to immunotherapy alone, as measured by tumor volume. The model accurately predicts the temporal evolution of five different treatment scenarios, including control, hypoxic tumors that received immunotherapy, normoxic tumors that received immunotherapy, evofosfamide alone, and hypoxic tumors that received combination immunotherapy and evofosfamide. The average concordance correlation coefficient (CCC) between predicted and observed tumor volume is $ 0.86 \pm 0.05 $. Interestingly, the model values to fit those five treatment arms was unable to accurately predict the response of normoxic tumors to combination evofosfamide and immunotherapy (CCC = $ -0.064 \pm 0.003 $). However, guided by the sensitivity analysis to rank the most influential parameters on the tumor volume, we found that increasing the tumor death rate due to immunotherapy by a factor of $ 18.6 \pm 9.3 $ increases CCC of $ 0.981 \pm 0.001 $. To the best of our knowledge, this is the first study to mathematically predict and describe the increased efficacy of immunotherapy following evofosfamide.

Quantifying assays: inhibition of signalling pathways of cancer

Inhibiting a signalling pathway concerns controlling the cellular processes of a cancer cell's viability, cell division and death. Assay protocols created to see if the molecular structures of the drugs being tested have the desired inhibition qualities often show great variability across experiments, and it is imperative to diminish the effects of such variability while inferences are drawn. In this paper, we propose the study of experimental data through the lenses of a mathematical model depicting the inhibition mechanism and the activation-inhibition dynamics. The method is exemplified through assay data obtained from an experimental study of the inhibition of the chemokine receptor 4 (CXCR4) and chemokine ligand 12 (CXCL12) signalling pathway of melanoma cells. The quantitative analysis is conducted as a two step process: (i) deriving theoretically from the model the cell viability as a function of time depending on several parameters; (ii) estimating the values of the parameters by using the experimental data. The cell viability is obtained as a function of concentration of the inhibitor and time, thus providing a comprehensive characterization of the potential therapeutic effect of the considered inhibitor, e.g. $IC_{50}$ can be computed for any time point.

Dynamic parameterization of a modified SEIRD model to analyze and forecast the dynamics of COVID-19 outbreaks in the United States

The rapid spread of the numerous outbreaks of the coronavirus disease 2019 (COVID-19) pandemic has fueled interest in mathematical models designed to understand and predict infectious disease spread, with the ultimate goal of contributing to the decision making of public health authorities. Here, we propose a computational pipeline that dynamically parameterizes a modified SEIRD (susceptible-exposed-infected-recovered-deceased) model using standard daily series of COVID-19 cases and deaths, along with isolated estimates of population-level seroprevalence. We test our pipeline in five heavily impacted states of the US (New York, California, Florida, Illinois, and Texas) between March and August 2020, considering two scenarios with different calibration time horizons to assess the update in model performance as new epidemiologic data become available. Our results show a median normalized root mean squared error (NRMSE) of 2.38% and 4.28% in calibrating cumulative cases and deaths in the first scenario, and 2.41% and 2.30% when new data are assimilated in the second scenario, respectively. Then, 2-week (4-week) forecasts of the calibrated model resulted in median NRMSE of cumulative cases and deaths of 5.85% and 4.68% (8.60% and 17.94%) in the first scenario, and 1.86% and 1.93% (2.21% and 1.45%) in the second. Additionally, we show that our method provides significantly more accurate predictions of cases and deaths than a constant parameterization in the second scenario (p < 0.05). Thus, we posit that our methodology is a promising approach to analyze the dynamics of infectious disease outbreaks, and that our forecasts could contribute to designing effective pandemic-arresting public health policies.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00366-023-01816-9.

Tumor Evolution Models of Phase-Field Type with Nonlocal Effects and Angiogenesis

In this survey article, a variety of systems modeling tumor growth are discussed. In accordance with the hallmarks of cancer, the described models incorporate the primary characteristics of cancer evolution. Specifically, we focus on diffusive interface models and follow the phase-field approach that describes the tumor as a collection of cells. Such systems are based on a multiphase approach that employs constitutive laws and balance laws for individual constituents. In mathematical oncology, numerous biological phenomena are involved, including temporal and spatial nonlocal effects, complex nonlinearities, stochasticity, and mixed-dimensional couplings. Using the models, for instance, we can express angiogenesis and cell-to-matrix adhesion effects. Finally, we offer some methods for numerically approximating the models and show simulations of the tumor's evolution in response to various biological effects.

The Mathematical modeling of Cancer growth and angiogenesis by an individual based interacting system

We present a mathematical model for the complex system for the growth of a solid tumor. The system embeds proliferation of cells depending on the surrounding oxygen field, hypoxia caused by insufficient oxygen when the tumor reaches a certain size, consequent VEGF release and angiogenic new vasculature growth, re-oxygenation of the tumor and subsequent tumor growth restart. Specifically cancerous cells are represented by individual units, interacting as proliferating particles of a solid body, oxygen, and VEGF are fields with a source and a sink, and new angiogenic vasculature is described by a network of growing curves. The model, as shown by numerical simulations, captures both the time-evolution of the tumor growth before and after angiogenesis and its spatial properties, with different distribution of proliferating and hypoxic cells in the external and deep layers of the tumor, and the spatial structure of the angiogenic network. The microscopic description of the growth opens the possibility of tuning the model to patient-specific scenarios.

`Friend or foe' and decision making initiative in complex conflict environments

We present a novel mathematical model of two adversarial forces in the vicinity of a non-combatant population in order to explore the impact of each force pursuing specific decision-making strategies. Each force has the opportunity to draw support by enabling the decision-making initiative of the population, in tension with maintaining tactical and organisational effectiveness over their adversary. Each dynamic model component of force, population and decision-making, is defined by the archetypal Lanchester, Lotka-Volterra and Kuramoto-Sakaguchi models, with feedback between each component adding heterogeneity. Developing a scheme where cultural factors determine decision-making strategies for each force, this work highlights the parametric and topological factors that influence favourable results in a non-linear system where physical outcomes are highly dependent on the non-physical and cognitive nature of each force's intended strategy.

Towards integration of time-resolved confocal microscopy of a 3D in vitro microfluidic platform with a hybrid multiscale model of tumor angiogenesis

The goal of this study is to calibrate a multiscale model of tumor angiogenesis with time-resolved data to allow for systematic testing of mathematical predictions of vascular sprouting. The multi-scale model consists of an agent-based description of tumor and endothelial cell dynamics coupled to a continuum model of vascular endothelial growth factor concentration. First, we calibrate ordinary differential equation models to time-resolved protein concentration data to estimate the rates of secretion and consumption of vascular endothelial growth factor by endothelial and tumor cells, respectively. These parameters are then input into the multiscale tumor angiogenesis model, and the remaining model parameters are then calibrated to time resolved confocal microscopy images obtained within a 3D vascularized microfluidic platform. The microfluidic platform mimics a functional blood vessel with a surrounding collagen matrix seeded with inflammatory breast cancer cells, which induce tumor angiogenesis. Once the multi-scale model is fully parameterized, we forecast the spatiotemporal distribution of vascular sprouts at future time points and directly compare the predictions to experimentally measured data. We assess the ability of our model to globally recapitulate angiogenic vasculature density, resulting in an average relative calibration error of 17.7% ± 6.3% and an average prediction error of 20.2% ± 4% and 21.7% ± 3.6% using one and four calibrated parameters, respectively. We then assess the model's ability to predict local vessel morphology (individualized vessel structure as opposed to global vascular density), initialized with the first time point and calibrated with two intermediate time points. In this study, we have rigorously calibrated a mechanism-based, multiscale, mathematical model of angiogenic sprouting to multimodal experimental data to make specific, testable predictions.

Optimizing combination therapy in a murine model of HER2+ breast cancer

Human epidermal growth factor receptor 2 positive (HER2+) breast cancer is frequently treated with drugs that target the HER2 receptor, such as trastuzumab, in combination with chemotherapy, such as doxorubicin. However, an open problem in treatment design is to determine the therapeutic regimen that optimally combines these two treatments to yield optimal tumor control. Working with data quantifying temporal changes in tumor volume due to different trastuzumab and doxorubicin treatment protocols in a murine model of human HER2+ breast cancer, we propose a complete framework for model development, calibration, selection, and treatment optimization to find the optimal treatment protocol. Through different assumptions for the drug-tumor interactions, we propose ten different models to characterize the dynamic relationship between tumor volume and drug availability, as well as the drug-drug interaction. Using a Bayesian framework, each of these models are calibrated to the dataset and the model with the highest Bayesian information criterion weight is selected to represent the biological system. The selected model captures the inhibition of trastuzumab due to pre-treatment with doxorubicin, as well as the increase in doxorubicin efficacy due to pre-treatment with trastuzumab. We then apply optimal control theory (OCT) to this model to identify two optimal treatment protocols. In the first optimized protocol, we fix the maximum dosage for doxorubicin and trastuzumab to be the same as the maximum dose delivered experimentally, while trying to minimize tumor burden. Within this constraint, optimal control theory indicates the optimal regimen is to first deliver two doses of trastuzumab on days 35 and 36, followed by two doses of doxorubicin on days 37 and 38. This protocol predicts an additional 45% reduction in tumor burden compared to that achieved with the experimentally delivered regimen. In the second optimized protocol we fix the tumor control to be the same as that obtained experimentally, and attempt to reduce the doxorubicin dose. Within this constraint, the optimal regimen is the same as the first optimized protocol but uses only 43% of the doxorubicin dose used experimentally. This protocol predicts tumor control equivalent to that achieved experimentally. These results strongly suggest the utility of mathematical modeling and optimal control theory for identifying therapeutic regimens maximizing efficacy and minimizing toxicity.

Opportunities for improving brain cancer treatment outcomes through imaging-based mathematical modeling of the delivery of radiotherapy and immunotherapy

Immunotherapy has become a fourth pillar in the treatment of brain tumors and, when combined with radiation therapy, may improve patient outcomes and reduce the neurotoxicity. As with other combination therapies, the identification of a treatment schedule that maximizes the synergistic effect of radiation- and immune-therapy is a fundamental challenge. Mechanism-based mathematical modeling is one promising approach to systematically investigate therapeutic combinations to maximize positive outcomes within a rigorous framework. However, successful clinical translation of model-generated combinations of treatment requires patient-specific data to allow the models to be meaningfully initialized and parameterized. Quantitative imaging techniques have emerged as a promising source of high quality, spatially and temporally resolved data for the development and validation of mathematical models. In this review, we will present approaches to personalize mechanism-based modeling frameworks with patient data, and then discuss how these techniques could be leveraged to improve brain cancer outcomes through patient-specific modeling and optimization of treatment strategies.

Data-Driven Simulation of Fisher-Kolmogorov Tumor Growth Models Using Dynamic Mode Decomposition

The computer simulation of organ-scale biomechanistic models of cancer personalized via routinely collected clinical and imaging data enables to obtain patient-specific predictions of tumor growth and treatment response over the anatomy of the patient's affected organ. However, the simulation of the underlying spatiotemporal models can entail a prohibitive computational cost, which constitutes a barrier to the successful development of clinically-actionable computational technologies for personalized tumor forecasting. Here we propose to utilize Dynamic-Mode Decomposition (DMD), an unsupervised machine learning method, to construct a low-dimensional representation of cancer models and accelerate their simulation. We show that DMD may be applied to Fisher-Kolmogorov models, which constitute an established formulation to represent untreated solid tumor growth that can further accommodate other relevant cancer phenomena. Our results show that a DMD implementation of this model over a clinically-relevant parameter space can yield impressive predictions, with short to medium-term errors remaining under 1% and long-term errors remaining under 20%, despite very short training periods. In particular, we have found that, for moderate to high tumor cell diffusivity and low to moderate tumor cell proliferation rate, DMD reconstructions provide accurate, bounded-error reconstructions for all tested training periods. We posit that this data-driven approach has the potential to greatly reduce the computational overhead of personalized simulations of cancer models, thereby facilitating tumor forecasting, parameter identification, uncertainty quantification, and treatment optimization.

Integrating mechanism-based modeling with biomedical imaging to build practical digital twins for clinical oncology

Digital twins employ mathematical and computational models to virtually represent a physical object (e.g., planes and human organs), predict the behavior of the object, and enable decision-making to optimize the future behavior of the object. While digital twins have been widely used in engineering for decades, their applications to oncology are only just emerging. Due to advances in experimental techniques quantitatively characterizing cancer, as well as advances in the mathematical and computational sciences, the notion of building and applying digital twins to understand tumor dynamics and personalize the care of cancer patients has been increasingly appreciated. In this review, we present the opportunities and challenges of applying digital twins in clinical oncology, with a particular focus on integrating medical imaging with mechanism-based, tissue-scale mathematical modeling. Specifically, we first introduce the general digital twin framework and then illustrate existing applications of image-guided digital twins in healthcare. Next, we detail both the imaging and modeling techniques that provide practical opportunities to build patient-specific digital twins for oncology. We then describe the current challenges and limitations in developing image-guided, mechanism-based digital twins for oncology along with potential solutions. We conclude by outlining five fundamental questions that can serve as a roadmap when designing and building a practical digital twin for oncology and attempt to provide answers for a specific application to brain cancer. We hope that this contribution provides motivation for the imaging science, oncology, and computational communities to develop practical digital twin technologies to improve the care of patients battling cancer.

A continuum mechanical framework for modeling tumor growth and treatment in two- and three-phase systems

The growth and treatment of tumors is an important problem to society that involves the manifestation of cellular phenomena at length scales on the order of centimeters. Continuum mechanical approaches are being increasingly used to model tumors at the largest length scales of concern. The issue of how to best connect such descriptions to smaller-scale descriptions remains open. We formulate a framework to derive macroscale models of tumor behavior using the thermodynamically constrained averaging theory (TCAT), which provides a firm connection with the microscale and constraints on permissible forms of closure relations. We build on developments in the porous medium mechanics literature to formulate fundamental entropy inequality expressions for a general class of three-phase, compositional models at the macroscale. We use the general framework derived to formulate two classes of models, a two-phase model and a three-phase model. The general TCAT framework derived forms the basis for a wide range of potential models of varying sophistication, which can be derived, approximated, and applied to understand not only tumor growth but also the effectiveness of various treatment modalities.

Supermodeling in predictive diagnostics of cancer under treatment

Classical data assimilation (DA) techniques, synchronizing a computer model with observations, are highly demanding computationally, particularly, for complex over-parametrized cancer models. Consequently, current models are not sufficiently flexible to interactively explore various therapy strategies, and to become a key tool of predictive oncology. We show that, by using supermodeling, it is possible to develop a prediction/correction scheme that could attain the required time regimes and be directly used to support decision-making in anticancer therapies. A supermodel is an interconnected ensemble of individual models (sub-models); in this case, the variously parametrized baseline tumor models. The sub-model connection weights are trained from data, thereby incorporating the advantages of the individual models. Simultaneously, by optimizing the strengths of the connections, the sub-models tend to partially synchronize with one another. As a result, during the evolution of the supermodel, the systematic errors of the individual models partially cancel each other. We find that supermodeling allows for a radical increase in the accuracy and efficiency of data assimilation. We demonstrate that it can be considered as a meta-procedure for any classical parameter fitting algorithm, thus it represents the next - latent - level of abstraction of data assimilation. We conclude that supermodeling is a very promising paradigm that can considerably increase the quality of prognosis in predictive oncology.

Biologically-Based Mathematical Modeling of Tumor Vasculature and Angiogenesis via Time-Resolved Imaging Data

Tumor-associated vasculature is responsible for the delivery of nutrients, removal of waste, and allowing growth beyond 2-3 mm3. Additionally, the vascular network, which is changing in both space and time, fundamentally influences tumor response to both systemic and radiation therapy. Thus, a robust understanding of vascular dynamics is necessary to accurately predict tumor growth, as well as establish optimal treatment protocols to achieve optimal tumor control. Such a goal requires the intimate integration of both theory and experiment. Quantitative and time-resolved imaging methods have emerged as technologies able to visualize and characterize tumor vascular properties before and during therapy at the tissue and cell scale. Parallel to, but separate from those developments, mathematical modeling techniques have been developed to enable in silico investigations into theoretical tumor and vascular dynamics. In particular, recent efforts have sought to integrate both theory and experiment to enable data-driven mathematical modeling. Such mathematical models are calibrated by data obtained from individual tumor-vascular systems to predict future vascular growth, delivery of systemic agents, and response to radiotherapy. In this review, we discuss experimental techniques for visualizing and quantifying vascular dynamics including magnetic resonance imaging, microfluidic devices, and confocal microscopy. We then focus on the integration of these experimental measures with biologically based mathematical models to generate testable predictions.

Modeling of Glioma Growth with Mass Effect by Longitudinal Magnetic Resonance Imaging

It is well-known that expanding glioblastomas typically induce significant deformations of the surrounding parenchyma (i.e., the so-called ?mass effect?). In this study, we evaluate the performance of three mathematical models of tumor growth: 1) a reaction-diffusion-advection model which accounts for mass effect (RDAM), 2) a reaction-diffusion model with mass effect that is consistent only in the case of small deformations (RDM), and 3) a reaction-diffusion model that does not include the mass effect (RD). The models were calibrated with magnetic resonance imaging (MRI) data obtained during tumor development in a murine model of glioma (n = 9). We obtained T₂-weighted and contrast-enhanced T₁-weighted MRI at 6 time points over 10 days to determine the spatiotemporal variation in the mass effect and tumor concentration, respectively. We calibrated the three models using data 1) at the first four, 2) only at the first and fourth, and 3) only at the third and fourth time points. Each of these calibrations were run forward in time to predict the volume fraction of tumor cells at the conclusion of the experiment. The diffusion coefficient for the RDAM model (median of 10.65 ? 10^-3 mm²d^-1) is significantly less than those for the RD and RDM models (17.46 ? 10^-3 mm²d^-1 and 19.38 ? 10^-3 mm²d^-1, respectively). The tumor concentrations for the RD, RDM, and RDAM models have medians of 40.2%, 32.1%, and 44.7%, respectively, for the calibration using data from the first four time points. The RDM model most accurately predicts tumor growth, while the RDAM model presents the least variation in its estimates of the diffusion coefficient and proliferation rate. This study demonstrates that the mathematical models capture both tumor development and mass effect observed in experiments.

Integrating Quantitative Assays with Biologically Based Mathematical Modeling for Predictive Oncology

We provide an overview on the use of biological assays to calibrate and initialize mechanism-based models of cancer phenomena. Although artificial intelligence methods currently dominate the landscape in computational oncology, mathematical models that seek to explicitly incorporate biological mechanisms into their formalism are of increasing interest. These models can guide experimental design and provide insights into the underlying mechanisms of cancer progression. Historically, these models have included a myriad of parameters that have been difficult to quantify in biologically relevant systems, limiting their practical insights. Recently, however, there has been much interest calibrating biologically based models with the quantitative measurements available from (for example) RNA sequencing, time-resolved microscopy, and in vivo imaging. In this contribution, we summarize how a variety of experimental methods quantify tumor characteristics from the molecular to tissue scales and describe how such data can be directly integrated with mechanism-based models to improve predictions of tumor growth and treatment response.

Drug delivery: Experiments, mathematical modelling and machine learning

We address the problem of determining from laboratory experiments the data necessary for a proper modeling of drug delivery and efficacy in anticancer therapy. There is an inherent difficulty in extracting the necessary parameters, because the experiments often yield an insufficient quantity of information. To overcome this difficulty, we propose to combine real experiments, numerical simulation, and Machine Learning (ML) based on Artificial Neural Networks (ANN), aiming at a reliable identification of the physical model factors, e.g. the killing action of the drug. To this purpose, we exploit the employed mathematical-numerical model for tumor growth and drug delivery, together with the ANN - ML procedure, to integrate the results of the experimental tests and feed back the model itself, thus obtaining a reliable predictive tool. The procedure represents a hybrid data-driven, physics-informed approach to machine learning. The physical and mathematical model employed for the numerical simulations is without extracellular matrix (ECM) and healthy cells because of the experimental conditions we reproduce.

Mechanism-Based Modeling of Tumor Growth and Treatment Response Constrained by Multiparametric Imaging Data

Multiparametric imaging is a critical tool in the noninvasive study and assessment of cancer. Imaging methods have evolved over the past several decades to provide quantitative measures of tumor and healthy tissue characteristics related to, for example, cell number, blood volume fraction, blood flow, hypoxia, and metabolism. Mechanistic models of tumor growth also have matured to a point where the incorporation of patient-specific measures could provide clinically relevant predictions of tumor growth and response. In this review, we identify and discuss approaches that use multiparametric imaging data, including diffusion-weighted magnetic resonance imaging, dynamic contrast-enhanced magnetic resonance imaging, diffusion tensor imaging, contrast-enhanced computed tomography, [¹⁸F]fluorodeoxyglucose positron emission tomography, and [¹⁸F]fluoromisonidazole positron emission tomography to initialize and calibrate mechanistic models of tumor growth and response. We focus the discussion on brain and breast cancers; however, we also identify three emerging areas of application in kidney, pancreatic, and lung cancers. We conclude with a discussion of the future directions for incorporating multiparametric imaging data and mechanistic modeling into clinical decision making for patients with cancer.

A Coupled Mass Transport and Deformation Theory of Multi-constituent Tumor Growth

We develop a general class of thermodynamically consistent, continuum models based on mixture theory with phase effects that describe the behavior of a mass of multiple interacting constituents. The constituents consist of solid species undergoing large elastic deformations and compressible viscous fluids. The fundamental building blocks framing the mixture theories consist of the mass balance law of diffusing species and microscopic (cellular scale) and macroscopic (tissue scale) force balances, as well as energy balance and the entropy production inequality derived from the first and second laws of thermodynamics. A general phase-field framework is developed by closing the system through postulating constitutive equations (i.e., specific forms of free energy and rate of dissipation potentials) to depict the growth of tumors in a microenvironment. A notable feature of this theory is that it contains a unified continuum mechanics framework for addressing the interactions of multiple species evolving in both space and time and involved in biological growth of soft tissues (e.g., tumor cells and nutrients). The formulation also accounts for the regulating roles of the mechanical deformation on the growth of tumors, through a physically and mathematically consistent coupled diffusion and deformation framework. A new algorithm for numerical approximation of the proposed model using mixed finite elements is presented. The results of numerical experiments indicate that the proposed theory captures critical features of avascular tumor growth in the various microenvironment of living tissue, in agreement with the experimental studies in the literature.

IMAGE-DRIVEN BIOPHYSICAL TUMOR GROWTH MODEL CALIBRATION

We present a novel formulation for the calibration of a biophysical tumor growth model from a single-time snapshot, multiparametric magnetic resonance imaging (MRI) scan of a glioblastoma patient. Tumor growth models are typically nonlinear parabolic partial differential equations (PDEs). Thus, we have to generate a second snapshot to be able to extract significant information from a single patient snapshot. We create this two-snapshot scenario as follows. We use an atlas (an average of several scans of healthy individuals) as a substitute for an earlier, pretumor, MRI scan of the patient. Then, using the patient scan and the atlas, we combine image-registration algorithms and parameter estimation algorithms to achieve a better estimate of the healthy patient scan and the tumor growth parameters that are consistent with the data. Our scheme is based on our recent work (Scheufele et al., Comput. Methods Appl. Mech. Engrg., to appear), but we apply a different and novel scheme where the tumor growth simulation in contrast to the previous work is executed in the patient brain domain and not in the atlas domain yielding more meaningful patient-specific results. As a basis, we use a PDE-constrained optimization framework. We derive a modified Picard-iteration-type solution strategy in which we alternate between registration and tumor parameter estimation in a new way. In addition, we consider an ℓ ₁ sparsity constraint on the initial condition for the tumor and integrate it with the new joint inversion scheme. We solve the sub-problems with a reduced space, inexact Gauss-Newton-Krylov/quasi-Newton method. We present results using real brain data with synthetic tumor data that show that the new scheme reconstructs the tumor parameters in a more accurate and reliable way compared to our earlier scheme.

Optimal Control Theory for Personalized Therapeutic Regimens in Oncology: Background, History, Challenges, and Opportunities

Optimal control theory is branch of mathematics that aims to optimize a solution to a dynamical system. While the concept of using optimal control theory to improve treatment regimens in oncology is not novel, many of the early applications of this mathematical technique were not designed to work with routinely available data or produce results that can eventually be translated to the clinical setting. The purpose of this review is to discuss clinically relevant considerations for formulating and solving optimal control problems for treating cancer patients. Our review focuses on two of the most widely used cancer treatments, radiation therapy and systemic therapy, as they naturally lend themselves to optimal control theory as a means to personalize therapeutic plans in a rigorous fashion. To provide context for optimal control theory to address either of these two modalities, we first discuss the major limitations and difficulties oncologists face when considering alternate regimens for their patients. We then provide a brief introduction to optimal control theory before formulating the optimal control problem in the context of radiation and systemic therapy. We also summarize examples from the literature that illustrate these concepts. Finally, we present both challenges and opportunities for dramatically improving patient outcomes via the integration of clinically relevant, patient-specific, mathematical models and optimal control theory.

A hybrid model of tumor growth and angiogenesis: In silico experiments

Tumor associated angiogenesis is the development of new blood vessels in response to proteins secreted by tumor cells. These new blood vessels allow tumors to continue to grow beyond what the pre-existing vasculature could support. Here, we construct a mathematical model to simulate tumor angiogenesis by considering each endothelial cell as an agent, and allowing the vascular endothelial growth factor (VEGF) and nutrient fields to impact the dynamics and phenotypic transitions of each tumor and endothelial cell. The phenotypes of the endothelial cells (i.e., tip, stalk, and phalanx cells) are selected by the local VEGF field, and govern the migration and growth of vessel sprouts at the cellular level. Over time, these vessels grow and migrate to the tumor, forming anastomotic loops to supply nutrients, while interacting with the tumor through mechanical forces and the consumption of VEGF. The model is able to capture collapsing and breaking of vessels caused by tumor-endothelial cell interactions. This is accomplished through modeling the physical interaction between the vasculature and the tumor, resulting in vessel occlusion and tumor heterogeneity over time due to the stages of response in angiogenesis. Key parameters are identified through a sensitivity analysis based on the Sobol method, establishing which parameters should be the focus of subsequent experimental efforts. During the avascular phase (i.e., before angiogenesis is triggered), the nutrient consumption rate, followed by the rate of nutrient diffusion, yield the greatest influence on the number and distribution of tumor cells. Similarly, the consumption and diffusion of VEGF yield the greatest influence on the endothelial and tumor cell numbers during angiogenesis. In summary, we present a hybrid mathematical approach that characterizes vascular changes via an agent-based model, while treating nutrient and VEGF changes through a continuum model. The model describes the physical interaction between a tumor and the surrounding blood vessels, explicitly allowing the forces of the growing tumor to influence the nutrient delivery of the vasculature.

Cancer cell population growth kinetics at low densities deviate from the exponential growth model and suggest an Allee effect

Most models of cancer cell population expansion assume exponential growth kinetics at low cell densities, with deviations to account for observed slowing of growth rate only at higher densities due to limited resources such as space and nutrients. However, recent preclinical and clinical observations of tumor initiation or recurrence indicate the presence of tumor growth kinetics in which growth rates scale positively with cell numbers. These observations are analogous to the cooperative behavior of species in an ecosystem described by the ecological principle of the Allee effect. In preclinical and clinical models, however, tumor growth data are limited by the lower limit of detection (i.e., a measurable lesion) and confounding variables, such as tumor microenvironment, and immune responses may cause and mask deviations from exponential growth models. In this work, we present alternative growth models to investigate the presence of an Allee effect in cancer cells seeded at low cell densities in a controlled in vitro setting. We propose a stochastic modeling framework to disentangle expected deviations due to small population size stochastic effects from cooperative growth and use the moment approach for stochastic parameter estimation to calibrate the observed growth trajectories. We validate the framework on simulated data and apply this approach to longitudinal cell proliferation data of BT-474 luminal B breast cancer cells. We find that cell population growth kinetics are best described by a model structure that considers the Allee effect, in that the birth rate of tumor cells increases with cell number in the regime of small population size. This indicates a potentially critical role of cooperative behavior among tumor cells at low cell densities with relevance to early stage growth patterns of emerging and relapsed tumors.

This study applied principles that describe the growth dynamics of species within an ecosystem in a novel attempt to understand the growth of tumors. At low cell densities, cooperative interactions among cancer cells may influence growth in a manner reminiscent of the ecological “Allee effect,” in contrast to conventional logistic growth models.

The 2019 mathematical oncology roadmap

Whether the nom de guerre is Mathematical Oncology, Computational or Systems Biology, Theoretical Biology, Evolutionary Oncology, Bioinformatics, or simply Basic Science, there is no denying that mathematics continues to play an increasingly prominent role in cancer research. Mathematical Oncology-defined here simply as the use of mathematics in cancer research-complements and overlaps with a number of other fields that rely on mathematics as a core methodology. As a result, Mathematical Oncology has a broad scope, ranging from theoretical studies to clinical trials designed with mathematical models. This Roadmap differentiates Mathematical Oncology from related fields and demonstrates specific areas of focus within this unique field of research. The dominant theme of this Roadmap is the personalization of medicine through mathematics, modelling, and simulation. This is achieved through the use of patient-specific clinical data to: develop individualized screening strategies to detect cancer earlier; make predictions of response to therapy; design adaptive, patient-specific treatment plans to overcome therapy resistance; and establish domain-specific standards to share model predictions and to make models and simulations reproducible. The cover art for this Roadmap was chosen as an apt metaphor for the beautiful, strange, and evolving relationship between mathematics and cancer.

Coupling brain-tumor biophysical models and diffeomorphic image registration

We present SIBIA (Scalable Integrated Biophysics-based Image Analysis), a framework for joint image registration and biophysical inversion and we apply it to analyze MR images of glioblastomas (primary brain tumors). We have two applications in mind. The first one is normal-to-abnormal image registration in the presence of tumor-induced topology differences. The second one is biophysical inversion based on single-time patient data. The underlying optimization problem is highly non-linear and non-convex and has not been solved before with a gradient-based approach. Given the segmentation of a normal brain MRI and the segmentation of a cancer patient MRI, we determine tumor growth parameters and a registration map so that if we "grow a tumor" (using our tumor model) in the normal brain and then register it to the patient image, then the registration mismatch is as small as possible. This "coupled problem" two-way couples the biophysical inversion and the registration problem. In the image registration step we solve a large-deformation diffeomorphic registration problem parameterized by an Eulerian velocity field. In the biophysical inversion step we estimate parameters in a reaction-diffusion tumor growth model that is formulated as a partial differential equation (PDE). In SIBIA, we couple these two sub-components in an iterative manner. We first presented the components of SIBIA in "Gholami et al., Framework for Scalable Biophysics-based Image Analysis, IEEE/ACM Proceedings of the SC2017", in which we derived parallel distributed memory algorithms and software modules for the decoupled registration and biophysical inverse problems. In this paper, our contributions are the introduction of a PDE-constrained optimization formulation of the coupled problem, and the derivation of a Picard iterative solution scheme. We perform extensive tests to experimentally assess the performance of our method on synthetic and clinical datasets. We demonstrate the convergence of the SIBIA optimization solver in different usage scenarios. We demonstrate that using SIBIA, we can accurately solve the coupled problem in three dimensions (256³ resolution) in a few minutes using 11 dual-x86 nodes.

Coupling tumor growth and bio distribution models

We couple a tumor growth model embedded in a microenvironment, with a bio distribution model able to simulate a whole organ. The growth model yields the evolution of tumor cell population, of the differential pressure between cell populations, of porosity of ECM, of consumption of nutrients due to tumor growth, of angiogenesis, and related growth factors as function of the locally available nutrient. The bio distribution model on the other hand operates on a frozen geometry but yields a much refined distribution of nutrient and other molecules. The combination of both models will enable simulating the growth of a tumor in a whole organ, including a realistic distribution of therapeutic agents and allow hence to evaluate the efficacy of these agents.

An adjoint-based method for a linear mechanically-coupled tumor model: Application to estimate the spatial variation of murine glioma growth based on diffusion weighted magnetic resonance imaging

We present an efficient numerical method to quantify the spatial variation of glioma growth based on subject-specific medical images using a mechanically-coupled tumor model. The method is illustrated in a murine model of glioma in which we consider the tumor as a growing elastic mass that continuously deforms the surrounding healthy-appearing brain tissue. As an inverse parameter identification problem, we quantify the volumetric growth of glioma and the growth component of deformation by fitting the model predicted cell density to the cell density estimated using the diffusion-weighted magnetic resonance imaging (DW-MRI) data. Numerically, we developed an adjoint-based approach to solve the optimization problem. Results on a set of experimentally measured, in vivo rat glioma data indicate good agreement between the fitted and measured tumor area and suggest a wide variation of in-plane glioma growth with the growth-induced Jacobian ranging from 1.0 to 6.0.

Mathematical models of tumor cell proliferation: A review of the literature

INTRODUCTION

A defining hallmark of cancer is aberrant cell proliferation. Efforts to understand the generative properties of cancer cells span all biological scales: from genetic deviations and alterations of metabolic pathways to physical stresses due to overcrowding, as well as the effects of therapeutics and the immune system. While these factors have long been studied in the laboratory, mathematical and computational techniques are being increasingly applied to help understand and forecast tumor growth and treatment response. Advantages of mathematical modeling of proliferation include the ability to simulate and predict the spatiotemporal development of tumors across multiple experimental scales. Central to proliferation modeling is the incorporation of available biological data and validation with experimental data. Areas covered: We present an overview of past and current mathematical strategies directed at understanding tumor cell proliferation. We identify areas for mathematical development as motivated by available experimental and clinical evidence, with a particular emphasis on emerging, non-invasive imaging technologies. Expert commentary: The data required to legitimize mathematical models are often difficult or (currently) impossible to obtain. We suggest areas for further investigation to establish mathematical models that more effectively utilize available data to make informed predictions on tumor cell proliferation.

Calibration of Multi-Parameter Models of Avascular Tumor Growth Using Time Resolved Microscopy Data

Two of the central challenges of using mathematical models for predicting the spatiotemporal development of tumors is the lack of appropriate data to calibrate the parameters of the model, and quantitative characterization of the uncertainties in both the experimental data and the modeling process itself. We present a sequence of experiments, with increasing complexity, designed to systematically calibrate the rates of apoptosis, proliferation, and necrosis, as well as mobility, within a phase-field tumor growth model. The in vitro experiments characterize the proliferation and death of human liver carcinoma cells under different initial cell concentrations, nutrient availabilities, and treatment conditions. A Bayesian framework is employed to quantify the uncertainties in model parameters. The average difference between the calibration and the data, across all time points is between 11.54% and 14.04% for the apoptosis experiments, 7.33% and 23.30% for the proliferation experiments, and 8.12% and 31.55% for the necrosis experiments. The results indicate the proposed experiment-computational approach is generalizable and appropriate for step-by-step calibration of multi-parameter models, yielding accurate estimations of model parameters related to rates of proliferation, apoptosis, and necrosis.

Selection and Validation of Predictive Models of Radiation Effects on Tumor Growth Based on Noninvasive Imaging Data

The use of mathematical and computational models for reliable predictions of tumor growth and decline in living organisms is one of the foremost challenges in modern predictive science, as it must cope with uncertainties in observational data, model selection, model parameters, and model inadequacy, all for very complex physical and biological systems. In this paper, large classes of parametric models of tumor growth in vascular tissue are discussed including models for radiation therapy. Observational data is obtained from MRI of a murine model of glioma and observed over a period of about three weeks, with X-ray radiation administered 14.5 days into the experimental program. Parametric models of tumor proliferation and decline are presented based on the balance laws of continuum mixture theory, particularly mass balance, and from accepted biological hypotheses on tumor growth. Among these are new model classes that include characterizations of effects of radiation and simple models of mechanical deformation of tumors. The Occam Plausibility Algorithm (OPAL) is implemented to provide a Bayesian statistical calibration of the model classes, 39 models in all, as well as the determination of the most plausible models in these classes relative to the observational data, and to assess model inadequacy through statistical validation processes. Discussions of the numerical analysis of finite element approximations of the system of stochastic, nonlinear partial differential equations characterizing the model classes, as well as the sampling algorithms for Monte Carlo and Markov chain Monte Carlo (MCMC) methods employed in solving the forward stochastic problem, and in computing posterior distributions of parameters and model plausibilities are provided. The results of the analyses described suggest that the general framework developed can provide a useful approach for predicting tumor growth and the effects of radiation.

A mechanically coupled reaction-diffusion model that incorporates intra-tumoural heterogeneity to predict in vivo glioma growth

While gliomas have been extensively modelled with a reaction-diffusion (RD) type equation it is most likely an oversimplification. In this study, three mathematical models of glioma growth are developed and systematically investigated to establish a framework for accurate prediction of changes in tumour volume as well as intra-tumoural heterogeneity. Tumour cell movement was described by coupling movement to tissue stress, leading to a mechanically coupled (MC) RD model. Intra-tumour heterogeneity was described by including a voxel-specific carrying capacity (CC) to the RD model. The MC and CC models were also combined in a third model. To evaluate these models, rats (n = 14) with C6 gliomas were imaged with diffusion-weighted magnetic resonance imaging over 10 days to estimate tumour cellularity. Model parameters were estimated from the first three imaging time points and then used to predict tumour growth at the remaining time points which were then directly compared to experimental data. The results in this work demonstrate that mechanical-biological effects are a necessary component of brain tissue tumour modelling efforts. The results are suggestive that a variable tissue carrying capacity is a needed model component to capture tumour heterogeneity. Lastly, the results advocate the need for additional effort towards capturing tumour-to-tissue infiltration.