Sensitivity analysis-guided model reduction of a mathematical model of pembrolizumab therapy for de novo metastatic MSI-H/dMMR colorectal cancer

Abstract: Colorectal cancer (CRC) is the third most commonly diagnosed cancer worldwide and the leading cause of cancer-related deaths in adults under 55, involving a complex interplay of biological processes such as dendritic cell (DC) maturation and migration, T cell activation and proliferation, cytokine production, and T cell and natural killer (NK) cell-mediated cancer cell killing. Microsatellite instability-high (MSI-H) CRC and deficient mismatch repair (dMMR) CRC constitute 15% of all CRC, and 4% of metastatic CRC, and exhibit remarkable responsiveness to immunotherapy, especially with PD-1 inhibitors such as pembrolizumab. Mathematical models of the underlying immunobiology and the interactions underpinning immune checkpoint blockade offer mechanistic insights into tumour-immune dynamics and provide avenues for treatment optimisation and the identification of novel therapeutic targets. We used our data-driven model of de novo metastatic MSI-H/dMMR CRC (dnmMCRC) and performed sensitivity analysis-guided model reduction using the FAST and EFAST methods. In this work, we constructed two simplified models of dnmMCRC: one that faithfully reproduces all of the original model's trajectories, and a second, minimal model that accurately replicates the original dynamics while being highly extensible for future inclusion of additional components to explore various aspects of the anti-tumour immune response.