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Table 1 Comparison of treatment outcomes for 5 strategies

From: Long range personalized cancer treatment strategies incorporating evolutionary dynamics

Strategy Median 2 Median 3 5 yr 2 5 yr 3 Cure 2 Cure 3
0: Current personalized medicine 585 720 35.8 29.6 23.0 10.8
Single-step strategy 2.2 1170 1080 47.3 40.5 30.1 17.6
Multistep strategy 2.2 1215 1080 47.5 41.5 30.1 18.5
ALTO-SMO 855 1035 44.7 41.8 34.3 17.9
ALTO 1260 1080 47.5 43.2 36.8 25.4
  1. Strategy 0 is the current personalized medicine strategy: treat with the best drug for the largest clone and continue to treat until tumor worsening or relapse, then rebiopsy and repeat. Strategy 2.2: select/adapt treatment every 45 days using evolutionary dynamic model to minimize the likelihood of forming a cell simultaneously resistant to all the therapies at a future reference timepoint, unless the estimated tumor burden is 1011 cells or more. Single-step strategy 2.2: future reference timepoint for selecting treatments is 45 days, corresponding to the interval between treatment adaptations. Multistep strategy 2.2: future reference timepoint for selecting treatments is 225 days, or 5 times the interval between treatment adaptations (“thinking 5 steps ahead”). ALTO: Adaptive long-term optimization. ALTO-SMO: Adaptive long term optimization-serial monotherapy only. Median 2: median survival days for two-drug cases. Median 3: median survival days for three-drug cases. 5 yr 2: percentage of two-drug cases with more than 5-year survival time. 5 yr 3: percentage of three-drug cases with more than 5-year survival time. Cure 2: percentage of two-drug cured cases. Cure 3: percentage of three-drug cured cases. Survival is defined as time before tumor grows to 1013 cells. This number is intended to represent the sum total of the cell numbers in a very large number of metastatic lesions, since most patients succumb to widespread metastatic disease. Cure is defined as total elimination of disease. Note that because the 3 drug simulation contains more states and allows doubly resistant cells at time zero, results from it cannot be directly compared to results from the two drug simulation