Mechanistic insights into the heterogeneous response to anti‐VEGF treatment in tumors

Abstract Vascular endothelial growth factor (VEGF) is a strong promoter of angiogenesis in tumors, and anti‐VEGF treatment, such as a humanized antibody to VEGF, is clinically used as a monotherapy or in combination with chemotherapy to treat cancer patients. However, this approach is not effective in all patients or cancer types. To better understand the heterogeneous responses to anti‐VEGF and the synergy between anti‐VEGF and other anticancer therapies, we constructed a computational model characterizing angiogenesis‐mediated growth of in vivo mouse tumor xenografts. The model captures VEGF‐mediated cross‐talk between tumor cells and endothelial cells and is able to predict the details of molecular‐ and cellular‐level dynamics. The model predictions of tumor growth in response to anti‐VEGF closely match the quantitative measurements from multiple preclinical mouse studies. We applied the model to investigate the effects of VEGF‐targeted treatment on tumor cells and endothelial cells. We identified that tumors with lower tumor cell growth rate and higher carrying capacity have a stronger response to anti‐VEGF treatment. The predictions indicate that the variation of tumor cell growth rate can be a main reason for the experimentally observed heterogeneous response to anti‐VEGF. In addition, our simulation results suggest a new synergy mechanism where anticancer therapy can enhance anti‐VEGF simply through reducing the tumor cell growth rate. Overall, this work generates novel insights into the heterogeneous response to anti‐VEGF treatment and the synergy of anti‐VEGF with other therapies, providing a tool that be further used to test and optimize anticancer therapy.