From fitting the average to fitting the individual: A cautionary tale for mathematicalmodelers

Abstract

An outstanding challenge in the clinical care of cancer is moving from a one-size-fits-all approach that relies on population-level statistics towards personalized therapeutic design. Mathematical modeling is a powerful tool in treatment personalization, as it allows for the incorporation of patient-specific data so that treatment can be tailor-designed to the individual. Herein, we work with a mathematical model of murine cancer immunotherapy that has been previously-validated against the average of an experimental dataset. We ask the question: what happens if we try to use this same model to perform personalized fits, and therefore make individualized treatment recommendations? Typically, this would be done by choosing a single fitting methodology, and a single cost function, identifying the individualized best-fit parameters, and extrapolating from there to make personalized treatment recommendations. Our analyses show the potentially problematic nature of this approach, as predicted personalized treatment response proved to be sensitive to the fitting methodology utilized. We also demonstrate how a small amount of the right additional experimental measurements could go a long way to improve consistency in personalized fits. Finally, we show how quantifying the robustness of the average response could also help improve confidence in personalized treatment recommendations. Author summaryAs we enter the era of healthcare where personalized medicine becomes a more common approach to treating cancer patients, harnessing the power of mathematical models will only become more essential. Using a preclinical dataset on cancer immunotherapy, we explore the challenges and limitations that arise when trying to move from fitting and making predictions for the population-level average, to fitting and making predictions for an individual. We find that the standard of approach of picking a single fitting methodology and a single cost function may end up having limited predictive value when applied to individual data. We also show how having a small amount of the right additional experimental data, and establishing the robustness of average treatment response, can help improve confidence in personalized model predictions.