WE‐E‐17A‐08: Prediction of Response to Neoadjuvant Chemotherapy Using a Mechanically Coupled Reaction‐Diffusion Model

Abstract

Purpose: To develop a clinically‐relevant patient‐specific modeling framework for oncology that is amenable to readily available clinical imaging data and yet retains the most salient features of response prediction. We use a mechanically coupled mathematical model of tumor growth that is initialized and constrained by MRI data early in the course of therapy, to guide the determination of model parameters and predict the response of breast cancers to neoadjuvant chemotherapy (NAC). Methods: We adopt a patient‐scale spatiotemporal tumor growth modeling framework and apply patient‐specific predictive modeling, constrained by quantitative imaging data, to a group of 26 patients exhibiting a varying degree of response to NAC. Dynamic contrast enhanced MRI, diffusion weighted MRI, and anatomical T1‐weighted MRI volumes were acquired prior to beginning NAC, after one cycle of NAC, and at the conclusion of NAC. Tumor response is parameterized using data from before and after the first cycle of therapy, and the model is driven forward in time to predict tumor burden at the conclusion of therapy. Model reconstructed parameters and predictions are retrospectively assessed for prognostic value in predicting patients that eventually respond or do not respond to NAC. Results: Using our mechanics‐coupled modeling approach, we are able to discriminate, after the first cycle of therapy, breast cancer patients that would eventually achieve a complete pathological response and those who would not, with an area under the receiver operator characteristic curve of 0.81, sensitivity of 90%, and specificity of 56%. Conclusion: We show the potential for model‐predictions at the conclusion of therapy for use as a prognostic indicator of response to therapy. This work provides considerable promise for predictive modeling centered on integrating quantitative in vivo imaging data with biomechanical models of tumor growth. National Institutes of Health NCI 1U01CA142565, NCI U01CA174706, NCI R25CA092043, NCI 1P50 098131, NCI P30CA68485, NCI R01CA138599, NINDS R01NS049251. The Vanderbilt initiative in Surgery and Engineering Pilot Award Program and the Whitaker Foundation.

Toward a Science of Tumor Forecasting for Clinical Oncology

“…An extension of the “personalized” reaction diffusion equation was put forward by Weis et al who coupled the random diffusion term to tissue mechanical properties (35). Applying this model to breast cancer patients receiving neoadjuvant chemotherapy achieved an area under the receiver operator characteristic curve of 0.81 for predicting, after the first cycle of treatment, which patients would go on to achieve a pathological complete response (36). …”