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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.

Optimization of antitumor radiotherapy represents an urgent issue, as approximately half of the patients diagnosed with cancer undergo radiotherapy during their treatment. Proton therapy is potentially more efficient than traditional X-ray radiotherapy due to fundamental differences in physics of dose deposition, leading to better targeting of tumors and less collateral damage to healthy tissue. There is increasing interest in the use of non-radioactive radiosensitizing tumor-specific nanoparticles the use of which can boost the performance of proton therapy. Such nanoparticles are small volumes of a sensitizer, such as boron-10 or various metal oxides, enclosed in a polymer layer containing tumor-specific antibodies, which allows for their targeted delivery to malignant cells. Furthermore, a combination of proton therapy with antiangiogenic therapy that normalizes tumor-associated microvasculature may yield further synergistic increase in overall treatment efficacy.

We have developed a spatially distributed mathematical model simulating the growth of a non-invasive tumor undergoing treatment by fractionated proton therapy with nanosensitizers and antiangiogenic therapy. The modeling results suggest that the most effective way to combine these treatment modalities should strongly depend on the tumor cells’ proliferation rate and their intrinsic radiosensitivity. Namely, a combination of antiangiogenic therapy with proton therapy, regardless of whether radiosensitizing nanoparticles are used, benefits treatment efficacy of rapidly growing tumors as well as radioresistant tumors with moderate growth rate. In these cases, administration of proton therapy simultaneously with antiangiogenic drugs after the initial single injection of nanosensitizers is the most effective option among those analyzed. Conversely, for slowly growing tumors, maximization of the number of nanosensitizer injections without antiangiogenic therapy proves to be a more efficient option, with enhancement in treatment efficacy growing with the increase of tumor radiosensitivity. However, the results also show that the overall efficacy of proton therapy is likely to increase only modestly with the addition of nanosensitizers and antiangiogenic drugs.

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.