A perfusion-based model to explain how paclitaxel achieves tumour-selective killing

Paclitaxel (taxol) is a commonly used chemotherapeutic that stabilizes microtubules to inhibit chromosome segregation during mitosis. Although it is used effectively to treat a wide variety of solid tumour types, it also impairs healthy cell proliferation leading to severe dose-limiting toxicities. Newer anti-mitotic drugs have been developed but these have so far failed to offer the same clinical benefit as paclitaxel, which begs the question of why this drug targets tumour cells so effectively? Here we develop a mathematical model of paclitaxel penetration and retention within 3D tumour environments following periodic drug-on/drug-off regimes typically used in the clinic. Our model suggests that during the drug-free periods, dense poorly-perfused tissue can retain paclitaxel for much longer than well-perfused tissue. This is due to paclitaxels ability to bind strongly to microtubules, which causes slower drug-release from densely packed tissue. Assuming that tumour cells are generally dense and less perfused than proliferative healthy tissues, this simple model suggests that tumour-selective killing could be achieved later in each chemotherapy cycle when the drug has otherwise cleared the healthy cell compartments. We use our model to optimize dosing regimens to allow paclitaxel to selectively kill tumour spheroids of different size, whilst sparing well-perfused healthy cells. Together, our model suggests paclitaxel could target key distinguishing features of many solid tumours: their size, 3D geometry and perfusion status. It is important to validate these predictions in cell models because, if correct, they could be harnessed to optimize paclitaxel use, to predict and enhance tumour responsiveness, and to develop newer drugs that are preferentially retained for longer within solid tumours.