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Interplay of mutations, alternate mechanisms, and treatment breaks in leukaemia: Understanding and implications studied with stochastic models
Linnaeus University, Faculty of Health and Life Sciences, Department of Chemistry and Biomedical Sciences.
Norwegian Univ Sci & Technol, Norway.
Linnaeus University, Faculty of Health and Life Sciences, Department of Chemistry and Biomedical Sciences. Faeth Therapeut Inc, USA. (Linnaeus Ctr Biomat Chem, BMC)ORCID iD: 0000-0001-8696-3104
2024 (English)In: Computers in Biology and Medicine, ISSN 0010-4825, E-ISSN 1879-0534, Vol. 169, article id 107826Article in journal (Refereed) Published
Abstract [en]

Bcr-Abl1 kinase domain mutations are the most prevalent cause of treatment resistance in chronic myeloid leukaemia (CML). Alternate resistance pathways nevertheless exist, and cell line experiments show certain patterns in the gain, and loss, of some of these alternate adaptations. These adaptations have clinical consequences when the tumour develops mechanisms that are beneficial to its growth under treatment, but slow down its growth when not treated. The results of temporarily halting treatment in CML have not been widely discussed in the clinic and there is no robust theoretical model that could suggest when such a pause in therapy can be tolerated. We constructed a dynamic model of how mechanisms such as Bcr-Abl1 overexpression and drug transporter upregulation evolve to produce resistance in cell lines, and investigate its behaviour subject to different treatment schedules, in particular when the treatment is paused ('drug holiday'). Our study results suggest that the presence of additional resistance mechanisms creates an environment which favours mutations that are either preexisting or occur late during treatment. Importantly, the results suggest the existence of tumour drug addiction, where cancer cells become dependent on the drug for (optimal) survival, which could be exploited through a treatment holiday. All simulation code is available at https://github.com/Sandalmoth/dual-adaptation.

Place, publisher, year, edition, pages
Elsevier, 2024. Vol. 169, article id 107826
Keywords [en]
Chronic myeloid leukaemia, Drug holiday, Targeted therapy
National Category
Cancer and Oncology Biochemistry and Molecular Biology
Research subject
Chemistry, Biochemistry
Identifiers
URN: urn:nbn:se:lnu:diva-127568DOI: 10.1016/j.compbiomed.2023.107826ISI: 001139605700001PubMedID: 38101118Scopus ID: 2-s2.0-85179884033OAI: oai:DiVA.org:lnu-127568DiVA, id: diva2:1836648
Available from: 2024-02-09 Created: 2024-02-09 Last updated: 2024-03-13Bibliographically approved

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Lindström, H. Jonathan G.Friedman, Ran

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