Ready Player One: Beating Cancer With Game Theory

That’s the first game: cancer stealthily emerging in the body.

And here, in theory, the rules change: Player One, this time, is the oncologist—and she or he often begins the game by attacking the cancer with massive doses of cytotoxic drugs.

That, indeed, is the proposition of a remarkable paper, entitled “Optimizing Cancer Treatment Using Game Theory,” which was published in the journal JAMA Oncology yesterday.

The “game” of cancer treatment (as opposed to cancer development itself) has two inherent asymmetries, the authors contend: The first is that there’s only one “rational” player—the oncologist.

Cancer cells don’t think or anticipate or plan out a strategy ahead of time; they adapt.

He or she delivers some sort of therapy to the patient and then the cancer cells respond to it—either by dying or evolving (developing resistance to the treatment).

But too often, as noted above, the oncologist surrenders both of these advantages by giving a single high-dose therapy or drug regimen for a set period of time, switching therapies only after the tumors begin to grow again:”By repeatedly administering the same drug(s) until disease progression,” Gatenby and colleagues explain, “the physician ‘plays’ a fixed strategy even as the opposing cancer cells continuously evolve successful adaptive responses.

Furthermore, by changing treatment only when the tumor progresses, the physician cedes leadership to the cancer cells and treatment failure becomes nearly inevitable.”

Or think of cancer therapy as a game of “rock-paper-scissors”—yes, this is their analogy, not mine.

“If almost all cells within the cancer play, for example, ‘paper,’ [it] is clearly advantageous for the treating physician to play ‘scissors.’

Yet, if the physician only plays ‘scissors,’ the cancer cells can evolve to the unbeatable resistance strategy of ‘rock.

One answer might be to try to “steer the cancer” through what they call “therapy probes”—administering smaller doses of different drugs over shorter periods of time to tease out the cancer cells’ various responses.

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