Use imaging to find the window when tumour blood vessels are working properly
Low doses of anti-blood-vessel drugs briefly make tumour vessels work better, which helps immune cells and other drugs get in. Scans can find that window for each patient.
Vascular normalisation after low-dose anti-angiogenic therapy is transient and dose-dependent, and DCE-MRI or perfusion CT can measure it patient by patient. Current anti-angiogenic and checkpoint combinations use fixed high doses and fixed schedules, so many patients are likely dosed outside their own normalisation window. Imaging-guided scheduling is a trial design intervention with existing drugs.
- Cold tumours and the immunosuppressive microenvironment · Most tumours keep the immune system out or asleep, so immunotherapy helps only a minority.
- Wrong doses · Most drug doses were chosen as the highest a person can tolerate, which is often more than they need.
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