Evolution-guided 'adaptive therapy' dosing tested in randomised phase 2 trials
Rather than hitting the tumour as hard as possible, adaptive therapy uses just enough drug to keep it in check, letting drug-sensitive cells suppress resistant ones. A small prostate cancer pilot was promising; randomised trials are needed.
Adaptive therapy modulates dosing on tumour burden (PSA, imaging or ctDNA), pausing when burden falls below a threshold and resuming when it rises, to maintain a population of sensitive cells that compete with resistant clones. A pilot in metastatic castration-resistant prostate cancer using abiraterone showed prolonged time to progression versus historical controls with roughly half the cumulative drug. The proposal is randomised phase 2 trials in prostate, melanoma and ovarian cancer with pre-specified adaptive algorithms.
- Wrong doses · Most drug doses were chosen as the highest a person can tolerate, which is often more than they need.
- Acquired resistance to every therapy · Nearly every targeted therapy stops working within months to a few years as the tumour adapts.
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not linked directly; found by shared links- IdeaA multi-cancer platform trial of adaptive (dose-holiday) therapy
Shares Moffitt Cancer Center, Wrong doses, Ovarian cancer, Melanoma.
- IdeaAutonomous closed-loop adaptive therapy driven by blood tests and evolutionary models
Shares Moffitt Cancer Center, Drug resistance (primary and acquired), Wrong doses, Acquired resistance to every therapy.
- PersonRobert A. Gatenby
Shares Moffitt Cancer Center, Drug resistance (primary and acquired), Prostate cancer.
- IdeaTest intermittent dosing of targeted drugs to delay resistance, with honest priors
Shares Drug resistance (primary and acquired), Wrong doses, Acquired resistance to every therapy, Melanoma.
- IdeaSwitch drugs at maximum response, not at relapse
Shares Moffitt Cancer Center, Acquired resistance to every therapy, Melanoma.
- IdeaSMART designs to test treatment strategies, not just single drugs
Shares Drug resistance (primary and acquired), Acquired resistance to every therapy, Prostate cancer.
- IdeaStarve the survivors: target the energy pathway drug-tolerant cells switch to
Shares Drug resistance (primary and acquired), Acquired resistance to every therapy, Melanoma.
- PersonShari Pilon-Thomas
Shares Moffitt Cancer Center, Melanoma.