Modeling the effects of EMT-immune dynamics on epithelial cancer progression

During progression from carcinoma in situ to an invasive tumor, the immune system is engaged in complex sets of interactions with various tumor cells. Tumor cell plasticity also alters disease trajectories via epithelial-to-mesenchymal transition (EMT). Several of the same pathways that regulate EMT are involved in tumor-immune interactions, yet little is known about the mechanisms and consequences of crosstalk between these regulatory processes. Here we introduce a multiscale evolutionary model to describe tumor-immune-EMT interactions and their impact on epithelial cancer progression from in situ to invasive disease. Through in silico analyses of large patient cohorts, we find controllable regions that maximize invasion-free survival. We identify that delaying tumor progression depends crucially on properties of the mesenchymal tumor cell phenotype: its growth rate and its immune-evasiveness. Through analysis of EMT-inflammation-associated data from The Cancer Genome Atlas, we find that association with EMT significantly worsens invasion-free survival probabilities in support of our model, and we predict new genes influencing outcomes in bladder and uterine cancer, including FGF pathway members. These results offer novel means to delay disease progression by regulating properties of EMT through specific gene interactions, and demonstrate the importance of studying cancer-immune interactions in light of EMT.