Gallagher Kit, Sousa Rachel S, Gatenbee Chandler, Schenck Ryan, Chen Peng, Citak Timon, Leither Sydney, Mazzacurati Lucia, Xella Agata, Zhou Zoe, Lemanne Dawn, Rodriguez Paulo, George Erin, Strobl Maximilian A R
Wolfson Centre for Mathematical Biology, Mathematical Institute, Oxford, UK.
Department of Integrated Mathematical Oncology, H. Lee Moffitt Cancer Center, Tampa, Florida, USA.
bioRxiv. 2025 Jul 16:2025.07.10.664235. doi: 10.1101/2025.07.10.664235.
High-grade serous ovarian cancer (HGSOC) remains a major clinical challenge. In particular among those patients with homologous recombination (HR)-proficient tumors (>50%), most eventually succumb to their disease due to high recurrence rates, acquired resistance, and cumulative toxicity. This report summarizes work from the 12 IMO Workshop in which we explored an alternative "extinction therapy" strategy for frontline treatment of HGSOC. Inspired by ecological principles, this multi-strike approach aims to eradicate tumors not through a singular "magic bullet" but through a series of therapies after standard frontline treatment when the tumor is still, and perhaps most, vulnerable. We present a framework leveraging mathematical modeling (MM) to develop personalized multi-strike protocols for HGSOC. Key contributions include: 1) An "IMOme" score using liquid biopsy data to assess patient-specific hematopoietic toxicity risk, guiding the timing and selection of subsequent therapies, 2) MM strategies to design effective low-dose combinations of targeted agents to achieve synthetic lethality while managing toxicity, and 3) A MM framework to analyze the interplay between chemotherapy, gut microbiome toxicity, and immunotherapy, demonstrating how mitigating microbiome damage could enhance immune response. Overall, the computational approaches presented herein aim to support the design of personalized, multi-strike regimens in the frontline setting that proactively target tumor extinction while managing toxicity, ultimately seeking to deliver cures for patients with HGSOC.
高级别浆液性卵巢癌(HGSOC)仍然是一项重大的临床挑战。特别是在那些同源重组(HR)功能正常的肿瘤患者中(超过50%),由于高复发率、获得性耐药和累积毒性,大多数患者最终会死于该疾病。本报告总结了第12届国际卵巢癌共识会议(IMO)研讨会的工作,在该研讨会上,我们探索了一种用于HGSOC一线治疗的替代“灭绝疗法”策略。受生态原理启发,这种多轮打击方法旨在根除肿瘤,不是通过单一的“神奇子弹”,而是在标准一线治疗后,当肿瘤仍然(也许是最)脆弱时,通过一系列疗法来实现。我们提出了一个利用数学建模(MM)为HGSOC制定个性化多轮打击方案的框架。主要贡献包括:1)使用液体活检数据评估患者特异性造血毒性风险的“IMOme”评分,指导后续治疗的时机和选择;2)设计有效的低剂量靶向药物组合以实现合成致死性同时控制毒性的MM策略;3)一个分析化疗、肠道微生物群毒性和免疫疗法之间相互作用的MM框架,证明减轻微生物群损伤如何增强免疫反应。总体而言,本文提出的计算方法旨在支持在一线治疗中设计个性化的多轮打击方案,该方案在控制毒性的同时积极靶向肿瘤灭绝,最终寻求为HGSOC患者带来治愈。