No matter how much I like modeling for the sake of modeling, or science for the sake of science, working in a hospital adds some constraints. At some point people look over at you measuring games in the Petri dish and ask “why are you doing this?” They expect an answer that involves something that benefits patients. That might mean prevention, early detection, or minimizing side-effects. But in most cases it means treatment: how does your work help us treat cancer? Here, I think, evolutionary game theory — and the Darwinian view of cancer more generally — offers a useful insight in the titular slogan: don’t treat the player, treat the game.
One of the most salient negative features of cancer is the tumour — the abnormal mass of cancer cells. It seems natural to concentrate on getting rid of these cells, or at least reducing their numbers. This is why tumour volume has become a popular surrogate endpoint for clinical trials. This is treating the player. Instead, evolutionary medicine would ask us to find the conditions that caused the system to evolve towards the state of having a large tumour and how we can change those conditions. Evolutionary therapy aims to change the environmental pressures on the tumour, such that the cancerous phenotypes are no longer favoured and are driven to extinction (or kept in check) by Darwinian forces. The goal is to change the game so that cancer proves to be a non-viable strategy.
In this post I want to look at the pairwise game version of my joint work with Robert Vander Velde, David Basanta, and Jacob Scott on the Warburg effect (Warburg, 1956; Gatenby & Gillies, 2004) and acid-mediated tumour invasion (Gatenby, 1995; Gatenby & Gawlinski, 2003). Since in this work we are concerned with the effects of acidity and vascularization on cancer dynamics, I will concentrate on interventions that affect acidity (buffer therapy; for early empirical work, see Robey et al., 2009) or vascularization (angiogenesis inhibitor therapy like bevacizumab).
My goal isn’t to say something new about these therapies, but to use them as illustrations for the importance of changing between qualitatively different dynamic regimes. In particular, I will be dealing with the oncological equivalent of a spherical cow in frictionless vacuum. I have tried to add some caveats in the footnotes, but these could be multiplied indefinitely without reaching an acceptably complete picture.
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