Numerical optimisation of chemotherapy dosage under antiangiogenic treatment in the presence of drug resistance

We consider a two-compartment model of chemotherapy resistant tumour growth under angiogenic signalling. Our model is based on the one proposed by Hahnfeldt et al. (1999), but we divide tumour cells into sensitive and resistant subpopulations. We study the influence of antiangiogenic treatment in combination with chemotherapy. The main goal is to investigate how sensitive are the theoretically optimal protocols to changes in parameters quantifying the interactions between tumour cells in the sensitive and resistant compartments, that is, the competition coefficients and mutation rates, and whether inclusion of an antiangiogenic treatment affects these results. Global existence and positivity of solutions and bifurcations (including bistability and hysteresis) with respect to the chemotherapy dose are studied. We assume that the antiangiogenic agents are supplied indefinitely and at a constant rate. Two optimisation problems are then considered. In the first problem a constant, indefinite chemotherapy dose is optimised to maximise the time needed for the tumour to reach a critical (fatal) volume. It is shown that maximum survival time is generally obtained for intermediate drug dose. Moreover, the competition coefficients have a more visible influence on survival time than the mutation rates. In the second problem, an optimal dosage over a short, 30-day time period, is found. A novel, explicit running penalty for drug resistance is included in the objective functional. It is concluded that, after an initial full-dose interval, an administration of intermediate dose is optimal over a broad range of parameters. Moreover, mutation rates play an important role in deciding which short-term protocol is optimal. These results are independent of whether antiangiogenic treatment is applied or not.