All issues

In the last decade along with classical cytotoxic agents, antiangiogenic drugs have been actively used in cancer chemotherapy. They are not aimed at killing malignant cells, but at blocking the process of angiogenesis, i.e., the growth of new vessels in the tumor and its surrounding tissues. Agents that stimulate angiogenesis, in particular, vascular endothelial growth factor, are actively produced by tumor cells in the state of metabolic stress. It is believed that blocking of tumor neovascularization should lead to a shortage of nutrients flow to the tumor, and thus can stop, or at least significantly slow down its growth. Clinical practice on the use of first antiangiogenic drug bevacizumab has shown that in some cases such therapy does not influence the growth rate of the tumor, whereas for other types of malignant neoplasms antiangiogenic therapy has a high antitumor effect. However, it has been shown that along with successful slowing of tumor growth, therapy with bevacizumab can induce directed tumor progression to a more invasive, and therefore more lethal, type. These data require theoretical analysis and rationale for the evolutionary factors that lead to the observation of epithelial-mesenchymal transition. For this purpose we have developed a spatially distributed mathematical model of growth and antiangiogenic therapy of heterogeneous tumor consisting of two subpopulations of malignant cells. One of subpopulations possesses inherent characteristics of epithelial phenotype, i.e., low motility and high proliferation rate, the other one corresponds to mesenchymal phenotype having high motility and low proliferation rate. We have performed the investigation of competition between these subpopulations of heterogeneous tumor in the cases of tumor growth without therapy and under bevacizumab monotherapy. It is shown that constant use of antiangiogenic drug leads to an increase of the region in parameter space, where the dominance of mesenchymal phenotype takes place, i.e., within a certain range of parameters in the absence of therapy epithelial phenotype is dominant but during bevacizumab administration mesenchymal phenotype begins to dominate. This result provides a theoretical basis of the clinically observed directed tumor progression to more invasive type under antiangiogenic therapy.

A mathematical model of tumor growth in tissue taking into account angiogenesis and antiangiogenic therapy is developed. In the model the convective flows in tissue are considered as well as individual motility of tumor cells. It is considered that a cell starts to migrate if the nutrient concentration falls lower than the critical level and returns into proliferation in the region with high nutrient concentration. Malignant cells in the state of metabolic stress produce vascular endothelial growth factor (VEGF), stimulating tumor angiogenesis, which increases the nutrient supply. In this work an antiangiogenic drug which bounds irreversibly to VEGF, converting it to inactive form, is modeled. Numerical analysis of influence of antiangiogenic drug concentration and efficiency on tumor rate of growth and structure is performed. It is shown that antiangiogenic therapy can decrease the growth of low-invasive tumor, but is not able to stop it completely.