RESUMEN
Adaptive therapy, an ecologically inspired approach to cancer treatment, aims to overcome resistance and reduce toxicity by leveraging competitive interactions between drug-sensitive and drug-resistant subclones, prioritizing patient survival and quality of life instead of killing the maximum number of cancer cells. In preparation for a clinical trial, we used endocrine-resistant MCF7 breast cancer to stimulate second-line therapy and tested adaptive therapy using capecitabine, gemcitabine, or their combination in a mouse xenograft model. Dose modulation adaptive therapy with capecitabine alone increased survival time relative to MTD but not statistically significantly (HR = 0.22, 95% CI = 0.043-1.1, p = 0.065). However, when we alternated the drugs in both dose modulation (HR = 0.11, 95% CI = 0.024-0.55, p = 0.007) and intermittent adaptive therapies, the survival time was significantly increased compared to high-dose combination therapy (HR = 0.07, 95% CI = 0.013-0.42, p = 0.003). Overall, the survival time increased with reduced dose for both single drugs (p < 0.01) and combined drugs (p < 0.001), resulting in tumors with fewer proliferation cells (p = 0.0026) and more apoptotic cells (p = 0.045) compared to high-dose therapy. Adaptive therapy favors slower-growing tumors and shows promise in two-drug alternating regimens instead of being combined.
RESUMEN
Highly effective cancer therapies often face limitations due to acquired resistance and toxicity. Adaptive therapy, an ecologically inspired approach, seeks to control therapeutic resistance and minimize toxicity by leveraging competitive interactions between drug-sensitive and drug-resistant subclones, prioritizing patient survival and quality of life over maximum cell kill. In preparation for a clinical trial in breast cancer, we used large populations of MCF7 cells to rapidly generate endocrine-resistance breast cancer cell line. We then mimicked second line therapy in ER+ breast cancers by treating the endocrine-resistant MCF7 cells in a mouse xenograft model to test adaptive therapy with capecitabine, gemcitabine, or the combination of those two drugs. Dose-modulation adaptive therapy with capecitabine alone increased survival time relative to MTD, but not statistically significant (HR: 0.22, 95% CI 0.043- 1.1 P = 0.065). However, when we alternated the drugs in both dose modulation (HR = 0.11, 95% CI: 0.024 - 0.55, P = 0.007) and intermittent adaptive therapies significantly increased survival time compared to high dose combination therapy (HR = 0.07, 95% CI: 0.013 - 0.42; P = 0.003). Overall, survival time increased with reduced dose for both single drugs (P < 0.01) and combined drugs (P < 0.001). Adaptive therapy protocols resulted in tumors with lower proportions of proliferating cells (P = 0.0026) and more apoptotic cells (P = 0.045). The results show that Adaptive therapy outperforms high-dose therapy in controlling endocrine-resistant breast cancer, favoring slower-growing tumors, and showing promise in two-drug alternating regimens.
RESUMEN
Does asking students to apply concepts from evolution to a fictional context, compared to a novel biological context, improve their understanding, exam performance or enjoyment of the material? Or does it harm their education by taking time away from true biology? At our institution, we sometimes ask students to apply life history theory to species from fictional movies, television shows or books. Previously, we had used a factual article on life history theory, to supplement our textbook. We wrote an alternative introduction to life history theory (included in the additional files for educational use), using Tolkien's fictional species from his Lord of the Rings books. We also introduce the biological species definition, sexual selection, sexual dimorphism, kin selection, and the handicap principle, as those concepts arose naturally in the discussion of the fictional species. Life history theory predicts strong correlations between traits affecting reproduction, growth and survival, which are all shaped by the ecology of the species. Thus, we can teach life history theory by asking students to infer traits and aspects of the ecology of a fictional species that have never been described, based on the partial information included in the fictional sources. In a large, third year undergraduate evolution course at Arizona State University, we randomized 16 tutorial sections of a total of 264 students to either read our article on the life history theory of Lord of the Rings, or the factual article we had used previously in the course. We found that the exam performance on life history questions for the two groups were almost identical, except that fans of The Lord of the Rings who had read our article did better on the exam. Enjoyment, engagement and interest in life history theory was approximately a full point higher on a 5-point Likert scale for the students that had read the fictional article, and was highly statistically significantly different (T-test p < 0.001 for all questions). There was no difference between the two groups in their familiarity or enjoyment of The Lord of the Rings stories themselves. Reading the article that taught life history theory by applying it to the species of The Lord of the Rings neither helped nor harmed exam performance, but did significantly improve student enjoyment, engagement and interest in life history theory, and even improved exam scores in students who liked The Lord of the Rings. Using fiction to teach science may also help to engage non-traditional students, such as world-builders, outside of our institutions of education. By encouraging students to apply the scientific ideas to their favorite stories from their own cultures, we may be able to improve both inclusivity and education. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12052-022-00160-8.
