Mathematical Optimization of Combination Therapy Regimens
by Helen Moore, Ph.D., Associate Director 
Quantitative Clinical Pharmacology 
Bristol-Myers Squibb; Princeton, NJ 
September 14, 2016
12:00 to 1:00 pm EDT

Register at http://rosaandco.com/webinarMoore.html

Abstract: Combination therapy is increasingly important, especially when 
resistance to drugs is a concern. However, finding the best possible doses to 
use can be challenging. If three drugs are to be combined, and there are 4 dose 
levels of each to be tested, this gives 43 dose combinations to test. Instead 
of running 64 studies, we can use mathematical modeling and simulation to gain 
insight into which dose levels should be combined to achieve optimal outcomes.
Essential components of optimizing outcomes include developing mathematical 
models of in-host disease dynamics, and quantifying the desired outcomes. 
Disease dynamics may be represented with semi-mechanistic models that include 
several cell types. Desired outcomes might include, for example, tumor size 
that is small at the end of treatment, but also not too large throughout the 
treatment period. Additionally, we don't want to use too much of any one drug, 
due to possible toxicity. Quantifying and giving relative weighting to these 
factors provide an objective that can be mathematically optimized.
I will discuss the optimal control framework and show examples in which control 
theory was applied to optimize combination therapy regimens. These include 
comparisons to more-traditional regimens, and optimization in the presence of 
constraints such as fixed allowable dose levels typical for patient therapies 
used in the clinic. 

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