The emergence of systems biology is now beginning to influence health care, through its early applications to drug discovery and its vision for personalized medicine [
Popel and Hunter 2009]. In discovering therapeutic targets for cancer treatment, it becomes imperative that more efforts be directed towards a quantitative approach to the analysis of therapeutic success and failure. It is our understanding that our cross-scale analysis technique can help to identify true, effective
therapeutic targets, because it accounts for both molecular and microenvironment factors of cancer, as well as for interactions among these factors. A target identified using a signaling pathway
in silico model alone may have little relevance for what happens
in vivo and later in clinics across the scales of interest. Such a potentially ‘false’-positive target may prove ineffective in an integrated, multiscale model early on. Indeed, it is increasingly agreed that considering the full biological context of therapeutic targets and moving beyond individual genes and proteins can increase the productivity of drug discovery [
Cho et al. 2006]. Multiscale cancer modeling paired with a cross-scale target evaluation technique provides such a new, effective framework for therapeutic target discovery. Moreover, our multiscale models may also facilitate the tracking of molecular components as the entire tumor system evolves (see [
Wang et al. 2009] for an example). Hence, this integrated approach, once the input data are personalized, can also be used to identify potential molecular
biomarkers, which may help to (1) determine which patients are likely to respond to a particular agent or regimen, and (2) indicate disease status and treatment progress in a particular patient. The
combination of targeted drugs is considered to be a promising strategy to improve treatment efficacy, reduce off-target effects and/or prevent evolution of drug resistance [
Borisy et al. 2003;
Chou 2006;
Keith et al. 2005]. It is intuitive to assume that the simultaneous inhibition of a cascade of some key regulating proteins could enhance the efficacy of the therapy, compared to inhibiting a single protein in isolation. In fact, clinical trials are currently in progress, to evaluate the efficacy of various drug combinations, including monoclonal antibodies and tyrosine kinase inhibitors [
Guarino et al. 2009], anti-receptor therapy with EGFR downstream signaling inhibitors [
Milton et al. 2007], and angiogenesis inhibitors [
Morabito et al. 2009]. However, these clinical trails indicate that there is little or only modest benefit from using combination therapy. From our systemic cross-scale analysis (the second example shown above), most of the combined parameter perturbations (inhibitions, amplifications, or a combination of both) indeed did not show improvement when compared to individual parameter inhibition or amplification treatments. More work will have to be done on this strategy in the future and, as demonstrated here, multiscale models can add value by generating reasonable, testable hypotheses as to which targets to hit when and in what combination.
While most promising, the field however faces a number of formidable technical
challenges. These include, for the multiscale cancer modeling part, dealing with data heterogeneity (as, for the foreseeable future, model parameters are likely obtained from different sources, disparate experimental settings, and a variety of cell lines), performing model parameter verification and model validation, and addressing the computational intensity issue when a model becomes more complicated (as more pathways and a richer microenvironmental milieu will need to be incorporated) [
Hunter and Borg 2003;
Walker and Southgate 2009]. As for the latter, we further note here that current models entirely or partly (i.e., hybrid models) developed with discrete modeling techniques can only handle a relatively small amount of cell populations, compared to pure continuum models, because they are too detailed to simulate over a long period of time, particularly in large, 3D domains. Hence, a more innovative way of thinking about modeling is required to solve this problem. New modeling methods, such as multiscale,
multi-resolution modeling [
Wang and Deisboeck 2008], iterative down-scaling and up-scaling processes [
Kevrekidis and Samaey 2009], and heterogeneous multiscaling [
Ren and E 2005] are exciting technical frontiers that require further examination. For the cross-scale analysis part, challenges include dealing with model parameter uncertainty, handling multiple outputs at the same time (we only have provided a pilot study in this review [
Wang et al. Submitted]), and taking into account multiple sensitivity analysis methods. The last point is crucial because each individual sensitivity analysis method has its advantages and disadvantages. In other words, there exists no single ultimate solution that best fits all types of applications [
Frey and Patil 2002;
Helton et al. 2006].
Despite these challenges, further advances in the technique of multiscale cancer modeling and related cross-scale analytic methods have the potential to add much needed insights as to why some drug treatments fail while others prove to be effective in controlling tumor expansion. In the future, one can imagine developing functional modules at different scales, specified to a particular cancer type and tailored to individual patients, thus using multiscale in silico modeling to advance the field of personalized predictive medicine.