Mechanistically informed adaptive dosing for cancer immunotherapy using AI-guided decision making

Abstract

Optimizing dose and schedule remains a central challenge in oncology drug development, particularly for immunotherapies where fixed dosing regimens often fail to account for patient specific heterogeneity in tumor-immune dynamics. Here, we present a hybrid quantitative systems pharmacology-reinforcement learning-Monte Carlo Tree Search (QSP-RL-MCTS) framework for personalized immunotherapy dosing that formulates dose selection as a sequential decision-making problem. The approach integrates a mechanistic QSP model of prostate cancer immunotherapy, transcriptomics informed virtual patient populations and data driven AI system comprising reinforcement learning and Monte Carlo tree search. Reinforcement learning is used to learn adaptive generalized dosing policies that optimize treatment outcomes across the population, while Monte Carlo Tree Search provides forward-looking evaluation of RL predicted dosing trajectories to refine patient-specific decisions. On benchmarking against fixed dosing regimens of ipilimumab, the remission rate of the proposed model (95.2%) was comparable to the highest fixed dosing regimen of 10 mg/kg per dose while the median total dose (72 mg/kg) of the proposed model designed regimen was comparable to the lowest fixed dosing regimen of 3 mg/kg per dose. The model is generalizable across different dosing protocols and can be extended to predict optimal dose under different therapeutic scenarios. Analysis of the learned dosing trajectories enables stratification of patients into distinct response groups and identifies drug activity rate as the dominant determinant of long-term treatment outcome. These results demonstrate how mechanistically guided artificial intelligence can transform population-level dose optimization into patient-specific, biologically interpretable treatment strategies for precision immuno-oncology.