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Are medical applications realistic?

Posted by krcrona on 25 Sep 2015 at 10:57 GMT

The authors write:

"Two major assumptions within our modeling are that drugs are administered for sufficiently long that evolution can converge to a local fitness optimum and that this convergence is guaranteed to occur."

In other words, the proposed strategy depends on using a drug for a very long time so that several mutations may occur, each one leading to more resistant types. During the process, the drug in use will work less well for each mutation. Would doctors keep using a drug which works less and less well? It seems possible that the patient would die
or, in a hospital setting, that an inefficient drug would be used for a long time before the shift to a better functioning drug
takes place. Comments from the authors or anyone with relevant medical expertise would be greatly appreciated.

Thanks,

Kristina Crona,
American University

No competing interests declared.
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RE: Are medical applications realistic?

jacobgscott replied to krcrona on 25 Sep 2015 at 21:37 GMT

Thank you for the comment Kristina - this is Jake, the last author on the paper. I am a physician - though for full disclosure I am an oncologist (and theoretician).

I do think that clinical applications are feasible, but this would, of course, need to be tested before we suggest beginning to use this strategy. While our model results are not specific as to time (as you correctly pointed out), there is plentiful evidence from many laboratories that suggest that these resistance events happen quickly, often within days.

In our next project, we will attempt to put a better number on this time, but for now, sufficiently long will have to do!

Best,

Jake

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