“Adaptive Therapy in Cancer Treatment" скачать в хорошем качестве

“Adaptive Therapy in Cancer Treatment"

May 25, 2022 - Cancer Patient Lab Session10 Discussion forum: https://community.cancerpatientlab.or... Full transcript: https://docs.google.com/document/d/1B... “I asked about bipolar androgen treatment. It's sort of taking the evolutionary approach that has been proposed to an extreme.” – Emma Shtivelman “Bob Gatenby's argument: He's saying that if you knock the population down successively, that's a way to get an extinction event. But if you hit the heterogeneous population all at once, up front, when there's a large population, you're going to get some resistant strains that are not going to respond. If you hit it with a combination, you'll get a better response. Progression free survival and the other metrics will look good, but you won't actually kill it off. There will be some resistant strains that are lurking there in the background, and they will eventually come back.” – Brad Power Meeting Summary In this meeting we discussed adaptive therapy, the approach described by Bob Gatenby based on evolutionary and game theory, which rests on four pillars: Low dose Drug combinations Sequencing (not a combination cocktail) Mathematical simulation models Please see the notes from the last meeting for details. Discussion Drug combinations: Everyone agreed that drug combinations that have a greater fit with identified biomarkers are preferred, but it is difficult to get oncologists to prescribe them. There should be trials that offer a couple of drugs, including investigational drugs. However, even if you want a combination of two approved drugs, they're considered a new drug (thereby lacking evidence) if you offer them together.  Sequencing: While sequencing drugs makes sense in theory, there is little evidence to support it from traditional clinical trials, while there is evidence that combination drug cocktails provide better patient outcomes.  Mathematical simulation models: Saed Sayad pointed out that the models that Bob Gatenby was using were very simple, and that models today are taking more variables into account, such as DNA, mRNA, and proteomics. Obstacles: Emma Shtivelman noted that physicians won’t prescribe drug combinations because there are few trials that have tested drug combinations. Even if each of two indicated approved drugs would provide a better outcome, physicians won’t prescribe the combination without clinical trial evidence. There should be clinical trials of drug combinations, including investigational drugs, but the obstacles are almost insurmountable. The combinatorics of a personalized treatment using multiple drugs at multiple doses and different sequencing choices make it nearly impossible to use a randomized clinical trial to derive supporting evidence. Requests Do you have any comments on adaptive therapy? This adaptive strategy seems intuitive, yet it’s not widely practiced. What are the barriers or objections to it? The information and opinions expressed on this website or platform, or during discussions and presentations (both verbal and written) are not intended as health care recommendations or medical advice by Cancer Patient Lab/Prostate Cancer Lab, its principals, presenters, participants, or representatives for any medical treatment, product, or course of action. You should always consult a doctor about your specific situation before pursuing any health care program, treatment, product or other course of action that might affect your health.