A multi-state model of chemoresistance to characterize phenotypic dynamics in breast cancer

The development of resistance to chemotherapy is a major cause of treatment failure in breast cancer. Although several molecular mechanisms of chemotherapeutic resistance are well studied, a quantitative understanding of the dynamics of resistant subpopulations within a heterogeneous tumor cell population remains elusive. While mathematical models describing the dynamics of heterogeneous cancer cell populations have been proposed, few have been experimentally validated due to the complex nature of resistance that limits the ability of a single phenotypic marker to sufficiently isolate drug resistant subpopulations. In this work, we address this problem with a combined experimental and modeling system that uses drug sensitivity data to reveal the composition of multiple subpopulations differing in their level of drug resistance. We calibrate time-resolved dose-response data to three mathematical models to interrogate the models’ ability to capture the dynamics of drug. All three models demonstrated an increase in population level resistance following drug exposure. The candidate models were compared by Akaike information criterion and the model selection criteria identified a multi-state model incorporating the role of population heterogeneity and cellular plasticity. To validate the ability of this model to identify the composition of subpopulations, we mixed wild-type MCF-7 and MCF-7/ADR resistant cells at various proportions and evaluated the corresponding model output. Our blinded two-state model was able to estimate the proportions of cell subtypes, with the measured proportions falling within the 95 percent confidence intervals on the parameter estimations and at an R-squared value of 0.986. To the best of our knowledge, this contribution represents the first work to combine experimental time-resolved drug sensitivity data with a mathematical model of resistance development.