Crowding governs resistance confinement and guides the improvement of adaptive therapy in a 2D melanoma model system

Abstract

The emergence of treatment resistant mutants is one of the primary contributors to therapy failure in cancer. Evolution-based adaptive therapies aim to exploit the competition between sensitive and resistant cells to prolong therapeutic control. However, in the densely packed tissues of solid tumors, competition is not only determined by cell-intrinsic factors but also a result of local physical interactions between neighboring cells. The successful development of physics-informed adaptive therapies therefore hinges upon the bottom-up integration of tissue mechanics and experimentally grounded models of tumor evolution. Here, we show how population-level treatment response emerges from mechanical interactions between individual cells. Combining genetically tailored therapy-mimicry experiments in spatially structured 2D melanoma colonies with mechanistic, particle-based tissue simulations as digital twins in a real-to-sim-to-real framework, we reveal how treatment-induced changes in mechanical crowding shape a cascade of resistance expansion, spatial competitive escape, and consequent therapy failure. We then link these underlying physical mechanisms to population-level observables in an abstracted mathematical model for reinforcement-learning-based therapy optimization and a distilled treatment-decision-heuristic, which we test experimentally. Together, our results identify mechanical crowding and escape as governing principles of resistance-mediated therapy failure in solid tumours and provide a basis for mechanistically informed, evolution-based treatment strategies.