Second-Order Effects of Chemotherapy Pharmacodynamics and Pharmacokinetics on Tumor Regression and Cachexia

by Luke Pierik, Patricia McDonald, Alexander R.A. Anderson & Jeffrey West. 

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Second order effects describe changes in a system which result from introducing variability or fluctuations in a system’s input. Quantifying second-order effects relies on an understanding of the convexity of an underlying function determining system output, and this has been effectively used in several fields, notably financial risk management. Previously, the vocabulary of fragile or antifragile has been used: fragile systems are harmed by variability while antifragile systems benefit from variability. The key insight here is that oncologists can control the input variability of treatment schedules, and therefore it is critical to define the fragility (or antifragility) of tumors. In cancer, second-order effects have been studied through dose response curves, which are ubiquitous theoretical and clinical tools in the field. However, these curves do not incorporate knowledge about how long dosages remain near the tumor (i.e. pharmacokinetics), which influences treatment outcomes. In this paper, we explore this relation between second-order effects and pharmacokinetics through standard mathematical models as well as a previously parameterized tumor model with 5-fluorouracil. By studying second-order effects with pharmacokinetics, more efficient treatment schedules may be devised which utilize the underlying convexity of dose response to produce greater patient outcomes.