"Treating tumours early or late?"Viossat, YannickAdaptive cancer therapy models typically assume that treatment resistant cells are fully resistant. The only way to limit their growth is thus to maintain competition with more sensitive tumour cells. A good strategy to maximise the time at which tumour size gets larger than a given threshold is then to stabilize tumour size at or close to this threshold. If resistant cells are only partially resistant, this is less clear: there is then a tension between treating little, to maintain competition with sensitive cells, and treating aggressively, to exploit the direct effect of treatment. Some models then suggest to use these weapons sequentially: first stabilize tumour size with a moderate dose, to exploit competition, and then switch abruptly to a maximal tolerated dose treatment. This may be seen by first studying an auxiliary question: assume that only a limited cumulative treatment dose may be given. Should the dose be given early or late? We will see that many models suggest to treat late. |
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