Computational design of improved standardized chemotherapy protocols for grade II oligodendrogliomas

PLoS Comput Biol. 2019 Jul 15;15(7):e1006778. doi: 10.1371/journal.pcbi.1006778. eCollection 2019 Jul.

Abstract

Here we put forward a mathematical model describing the response of low-grade (WHO grade II) oligodendrogliomas (LGO) to temozolomide (TMZ). The model describes the longitudinal volumetric dynamics of tumor response to TMZ of a cohort of 11 LGO patients treated with TMZ. After finding patient-specific parameters, different therapeutic strategies were tried computationally on the 'in-silico twins' of those patients. Chemotherapy schedules with larger-than-standard rest periods between consecutive cycles had either the same or better long-term efficacy than the standard 28-day cycles. The results were confirmed in a large trial of 2000 virtual patients. These long-cycle schemes would also have reduced toxicity and defer the appearance of resistances. On the basis of those results, a combination scheme consisting of five induction TMZ cycles given monthly plus 12 maintenance cycles given every three months was found to provide substantial survival benefits for the in-silico twins of the 11 LGO patients (median 5.69 years, range: 0.67 to 68.45 years) and in a large virtual trial including 2000 patients. We used 220 sets of experiments in-silico to show that a clinical trial incorporating 100 patients per arm (standard intensive treatment versus 5 + 12 scheme) could demonstrate the superiority of the novel scheme after a follow-up period of 10 years. Thus, the proposed treatment plan could be the basis for a standardized TMZ treatment for LGO patients with survival benefits.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
  • Brain Neoplasms / drug therapy*
  • Cohort Studies
  • Female
  • Humans
  • Male
  • Middle Aged
  • Oligodendroglioma / drug therapy*

Grants and funding

This research has been supported by grants awarded to VMPG by the Ministerio de Economia y Competitividad/FEDER, Spain (grant number MTM2015-71200-R), Junta de Comunidades de Castilla-La Mancha, Spain (grant number SBPLY/17/180501/000154) and James S. Mc. Donnell Foundation (United States of America) 21st Century Science Initiative in Mathematical and Complex Systems Approaches for Brain Cancer (Collaborative awards 220020560 and 220020450). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.