Virotherapy, using herpes simplex virus, represents a promising therapy of glioma. But the innate immune response, which includes TNF-α produced by macrophages, reduces the effectiveness of the treatment. Hence treatment with TNF-α inhibitor may increase the effectiveness of the virotherapy. In the present paper we develop a mathematical model that includes continuous infusion of the virus in combination with TNF-α inhibitor. We study the efficacy of the treatment under different combinations of the two drugs for different scenarios of the burst size of newly formed virus emerging from dying infected cancer cells. The model may serve as a first step toward developing an optimal strategy for the treatment of glioma by the combination of TNF-α inhibitor and oncolytic virus injection.
Abstract. We consider an optimal control problem for a general mathematical model of drug treatment with a single agent. The control represents the concentration of the agent and its effect (pharmacodynamics) is modelled by a Hill function (i.e., Michaelis-Menten type kinetics). The aim is to minimize a cost functional consisting of a weighted average related to the state of the system (both at the end and during a fixed therapy horizon) and to the total amount of drugs given. The latter is an indirect measure for the side effects of treatment. It is shown that optimal controls are continuous functions of time that change between full or no dose segments with connecting pieces that take values in the interior of the control set. Sufficient conditions for the strong local optimality of an extremal controlled trajectory in terms of the existence of a solution to a piecewise defined Riccati differential equation are given.
We analyze the structure of optimal protocols for a mathematical model of tumor anti-angiogenic treatment. The control represents the concentration of the agent and we consider the problem to administer an a priori given total amount of agents in order to achieve a minimum tumor volume/maximum tumor reduction. In earlier work, this problem was studied with a log-kill type pharmacodynamic model for drug effects which does not account for saturation of the drug concentration. Here we study the effect of incorporating a Michaelis-Menten (MM) or Emax-type pharmacodynamic model, the most commonly used model in the field of pharmacometrics. We compare the formulations of both problems and the resulting solutions. The reformulated problem with Emax pharmacodynamics is no longer linear in the control. This results in qualitative changes in the structure of optimal controls which, in line with an interpretation as concentrations, now are continuous while discontinuities exist if the log-kill model is used which is more in line with an interpretation of the control as dose rates. In spite of these qualitative differences, similarities in the structures of solutions can be observed. Both aspects are discussed theoretically and illustrated numerically.
An optimal control problem for an abstract mathematical model for cancer chemotherapy is considered. The dynamics is for a single drug and includes pharmacodynamic (PD) and pharmacokinetic (PK) models. The aim is to point out qualitative changes in the structures of optimal controls that occur as these pharmacometric models are varied. This concerns (i) changes in the PD-model for the effectiveness of the drug (e.g., between a linear log-kill term and a non-linear Michaelis-Menten type $E_{\max}$-model) and (ii) the question how the incorporation of a mathematical model for the pharmacokinetics of the drug effects optimal controls. The general results will be illustrated and discussed in the framework of a mathematical model for anti-angiogenic therapy.
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