Smarter timing of cancer treatments could improve cure rates, study suggests

A new study provides hope that smarter timing of cancer treatments could improve cure rates.

The study’s Principal Investigator, Dr Robert Noble, Senior Lecturer in the Department of Mathematics, City, St George’s, University of London, sought to address a major problem in cancer care.

Although tumors may initially shrink under treatment, in many cases they eventually grow back. These relapses come from a small number of cancer cells that have acquired mutations, making the cells resistant to treatment.”

Dr. Robert Noble, Senior Lecturer in the Department of Mathematics, City, St George’s, University of London

The standard clinical approach is to wait and see if a tumor recurs before trying a different treatment. At this point, some tumor cells are likely to have acquired mutations, making them resistant to the second treatment, which also fails.

Evolutionary theory suggests an alternative strategy. Rather than waiting, it may be best to switch to a second treatment while the tumor is still responding to the first. This “kick it while it’s down” approach is most appropriate when doctors know from experience that even the best choice for a first treatment often fails due to resistance.

As Dr Noble explains in a podcast about the study, “evolutionary approaches have been very successful in other contexts, such as fighting antibiotic resistance or predicting which vaccines we should use in a particular flu season. There is every reason to believe that similar approaches should work in tumors.”

To test this hypothesis, Dr. Noble and his colleagues adapted mathematical methods most commonly used to understand how plants and animals evolve in response to environmental stresses such as climate change.

In their study, the team concludes that their findings warrant further experimental and clinical testing of this innovative evolutionary therapy strategy. Three small clinical trials are already underway for soft tissue cancer, prostate cancer and breast cancer. Further tests are in progress.

“Our models predict that this new approach will generally perform better than the standard of care,” explains Dr. Noble. “A sequence of two treatments, even if optimally timed, is likely to succeed only in relatively small tumors. But we have reason to hope that alternating between three or more treatments, following the same principle, could eradicate larger tumors.”