A Validated Mathematical Model of FGFR3-Mediated Tumor Growth Reveals
Pathways to Harness the Benefits of Combination Targeted Therapy and
Immunotherapy in Bladder Cancer
Abstract
Bladder cancer is a common malignancy with over 80,000 estimated new
cases and nearly 18,000 deaths per year in the United States alone.
Therapeutic options for metastatic bladder cancer had not evolved much
for nearly four decades, until recently, when five immune checkpoint
inhibitors were approved by the FDA. Despite the activity of these drugs
in some patients, the objective response rate for each is less than
25%. At the same time, fibroblast growth factor receptors (FGFRs) have
been attractive drug targets for a variety of cancers, and in 2019 the
FDA approved the first therapy targeted against FGFR3 for bladder
cancer. Given the excitement around these new receptor tyrosine kinase
and immune checkpoint targeted strategies, and the challenges they each
may face on their own, emerging data suggest that combining these
treatment options could lead to improved therapeutic outcomes. In this
paper, we develop a mathematical model for FGFR3-mediated tumor growth
and use it to investigate the impact of the combined administration of a
small molecule inhibitor of FGFR3 and a monoclonal antibody against the
PD-1/PD-L1 immune checkpoint. The model is carefully calibrated and
validated with experimental data before survival benefits and dosing
schedules are explored. Predictions of the model suggest that FGFR3
mutation reduces the effectiveness of anti-PD-L1 therapy, that there are
regions of parameter space where each monotherapy can outperform the
other, and that pretreatment with anti-PD-L1 therapy always results in
greater tumor reduction even when anti-FGFR3 therapy is the more
effective monotherapy.