Predicting Personalised Therapeutic Combinations in Non-Small Cell Lung Cancer Using In Silico Modelling

The disease burden from non-small cell lung cancer (NSCLC) adenocarcinoma is substantial, with around a million new cases diagnosed globally each year, and a 5-year survival rate of less than 20%. A lack of therapeutic options personalized to individual patient genetics, and the targeted therapies that exist quickly succumbing to resistance, leads to high variation in survival. Patient stratification combined with greater personalisation of therapies have the potential to improve outcomes, however, the wide variation in mutations found in NSCLC adenocarcinoma patients mean that experimentally determining suitable treatment combinations is time-consuming and expensive. Here we present an in silico model encompassing tumour intrinsic key oncogenic signalling pathways, including EGFR, AKT, JAK/STAT and WNT for efficiently predicting rational drug-drug and drug-radiotherapy combination therapies in NSCLC. Using this model, we simulate diverse genetic profiles and test over 10,000 therapeutic combinations to identify optimal strategies to overcome resistance mechanisms specific to genetic profiles and p53 status. Our in silico model reproduces drug additivity experiments, predicts radio-sensitising genes validated in a CRISPR screen and identifies 53BP1 as a potential drug target that improves the therapeutic window during radiotherapy, as well as potential to use ATM inhibitors to overcome p53 loss-of-function driven radiotherapy resistance. We further use the in silico model to identify a 19-gene signature to stratify patients most likely to benefit from radiotherapy and validated this using TCGA data. These results further demonstrate the utility of in silico mechanistic modelling and present a bespoke computational resource for large-scale screening of personalised therapies applied to NSCLC.