SMART-ACT: Spatial Methodologic Approaches for Risk Assessment and Therapeutic Adaptation in Cancer Treatment

Head and neck squamous carcinomas affect all ethnicities and age groups, accounting for significant mortality and therapy­related side­effects. Over 50,000 new cases are diagnosed each year in the United States, leading to large, rich repositories of patient data. For each of these cases, oncologists need to anticipate survival, oncologic, and side­effect outcomes associated with treatment strategies in order to select a treatment which balances efficacy and toxicity. However, despite the wealth of data available, risk prediction algorithms for cancers are rudimentary and incorporate only a handful of patient characteristics, largely due to a lack of computational methodologies. We propose to develop a computational methodology that supports the construction of a validated precision model of patient­specific outcomes for head and neck cancers, based on demographics, toxicity, and complex imaging data. Our ensemble methodology will be revolutionary in that it will be the first in the field to include both imaging and non­imaging data, while taking into account large­scale biological and clinical correlates. The approach is innovative through its leverage of big data repositories and through its unique blend of computational modeling principles from bioengineering, statistics, and computer science. These methods allow us to incorporate diverse data types, handle missing data, and model multiple outcomes. From a clinical perspective, this integrative approach is novel in the field of cancer therapy. The resulting model and web­based environment will mark a significant advance in biomedical computing because it will be able to identify, for the first time, specific subgroups who are at risk for distinct oncologic, toxicity, and survival profiles. Furthermore, the ?current clinical practice paradigm for head and neck treatment is stage­driven. With validation, this novel approach can identify patients based not on clinical staging, but on precision modeling using cohort data and similar sets of patients. The methodology is applicable to clinical practice involving human subjects and has the potential to change the standard of care and outcomes of treatment in the field.