Tell me about Bob Gatenby's work on adaptive therapy

Bob Gatenby's Adaptive Therapy Approach

I found several webinars featuring Dr. [removed] Gatenby from Moffitt Cancer Center discussing his innovative work on adaptive therapy. Here are the specific sessions available:

Available Webinars by Bob Gatenby

1. "An Evolutionary Treatment Strategy" [Webinar #9]

Date: [date removed] URL: https://www.leafscience.org/webinar-9/

This foundational session covers Dr. [removed] core principles for treating advanced cancers using evolutionary biology and game theory.

2. "Latest Insights from Applying Evolutionary Theory to the Treatment Strategies of Cancer Patients" [Webinar #154]

URL: https://www.leafscience.org/webinar-154/

This is his most recent update, featuring new trial data and the "directed evolution" strategy he's developed.

3. "Bipolar Androgen Therapy" [Webinar #21]

Co-presented with Bryce Olson URL: https://www.leafscience.org/webinar-21/

This session applies adaptive therapy principles specifically to prostate cancer treatment using testosterone cycling.

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Core Concepts of Adaptive Therapy

The Problem He's Solving

Most cancer treatment follows a "maximum tolerated dose until failure" approach—doctors give the highest dose possible until the cancer stops responding. Dr. [removed] explains why this backfires:

• Cancer evolves resistance. When you continuously blast cancer with maximum doses, you kill the treatment-sensitive cells but leave behind resistant cells that can now proliferate unopposed.
• It's like playing chess poorly. The oncologist has the advantage of moving first and being strategic, but most doctors don't use that advantage.

The Adaptive Therapy Strategy

Instead of continuous maximum dosing, Dr. [removed] proposes cycling therapy on and off:

The Key Principle: Use treatment-sensitive cells to control resistant cells.

1. Treat strategically - Give enough treatment to knock the tumor back (about 50% PSA decline in prostate cancer)
2. Stop treatment - Allow the tumor to grow back
3. Why this works - Treatment-sensitive cells don't carry the genetic burden of resistance mechanisms, so they have a fitness advantage and outcompete resistant cells
4. Repeat cycles - Continue this on-off pattern

Real-World Results from His Research

According to Webinar #154, Dr. [removed] trials show impressive outcomes:

• 28-month survival difference: Patients on adaptive therapy survived significantly longer than those on standard continuous dosing
• Cost reduction: $70,000 per patient per year in reduced drug costs
• Treatment burden: Patients received treatment only 46-54% of the time (meaning they were off treatment half the time)
• Long-term survivors: Some patients have remained stable on adaptive therapy for 6-8+ years
• Median time to progression: Now exceeds 6-7 years (compared to standard approaches)

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Key Treatment Principles He Emphasizes

1. Low Dose Strategy

Hit tumors hard enough to disrupt their system, but not so hard that you eliminate all sensitive cells and leave only resistant ones.

2. Combinations & Sequencing

• Use multiple "pretty good" treatments in sequence rather than one "magic bullet"
• Sequence treatments rather than combining them all at once (combination cocktails select for resistance to everything simultaneously)

3. Mathematical Modeling

Dr. [removed] emphasizes that cancer is a nonlinear dynamic system—human intuition fails here. He uses mathematical models to:

• Predict tumor behavior
• Guide dosing decisions
• Optimize treatment timing

4. Personalized Monitoring

For prostate cancer specifically, he tracks:

• PSA levels (prostate-specific antigen)
• Testosterone levels - ensuring rapid recovery when stopping androgen deprivation therapy
• Treatment response patterns - each patient's cancer behaves differently

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The "Directed Evolution" Strategy (New Development)

In Webinar #154, Dr. [removed] introduces an advanced approach:

Concept: Instead of just cycling therapy on/off, deliberately use testosterone injections to kill resistant cells that have upregulated their androgen receptors (become "addicted" to high testosterone).

How it works:

• Resistant cells adapt by making more androgen receptors
• A sudden testosterone spike kills these over-adapted cells
• This can restore sensitivity to standard treatments

Results: One patient case showed successful transition from resistant to sensitive cancer cells through this approach.

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Important Context: His Unique Approach

Dr. [removed] is distinctive because:

✅ He brings strategic thinking to cancer treatment (rare in oncology)
✅ He combines evolutionary biology with clinical practice
✅ He uses mathematical models to guide decisions (not just intuition)
✅ He challenges the standard "maximum tolerated dose" paradigm
✅ His work is being applied to multiple cancer types (prostate, renal cancer, others)

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Questions to Ask Your Oncologist

If you're interested in adaptive therapy approaches:

1. "Is adaptive therapy appropriate for my specific cancer type and stage?"
2. "What biomarkers would you monitor if we used a cycling approach?"
3. "How frequently would I need testing (labs, imaging) with this strategy?"
4. "Are there clinical trials using adaptive therapy that I might be eligible for?"
5. "How would this approach compare to standard continuous dosing for my situation?"

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Where to Learn More

• Contact Dr. [removed] team: [email removed] (Moffitt Cancer Center)
• Collaborating physician: Dr. [removed] Lemanne ([email removed]) - works with Gatenby's team on individualized strategies
• Related webinars on mathematical modeling and personalized dosing are also available through Cancer Patient Lab

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This information is for educational purposes only. Always consult your healthcare team for personalized medical advice and decisions.