Reinforcement Learning with Action-Derived Rewards for Chemotherapy and Clinical Trial Dosing Regimen Selection

Unstructured learning problems without well-defined rewards are unsuitable for current reinforcement learning (RL) approaches. Action-derived rewards can allow RL agents to fully explore state and action trade-offs in scenarios that require specific outcomes yet are unstructured by external reward. Clinical trial dosing choice is an example of such a problem. We report the successful formulation of clinical trial dosing choice as an RL problem using action-based rewards and learning of dosing regimens to reduce mean tumor diameters (MTD) in patients undergoing simulated temozolomide (TMZ) and procarbazine, 1-(2-chloroethyl)-3-cyclohexyl-l-nitrosourea, and vincristine (PCV) chemo- and radiotherapy clinical trials. The use of action-derived rewards as partial proxies for outcomes is described for the first time. Novel dosing regimens learned by an RL agent in the presence of action-derived rewards achieve significant reduction in MTD for cohorts and individual patients in simulated TMZ and PCV clinical trials while reducing treatment cycle administrations and dosage concentrations compared to human-expert dosing regimens. Our approach can be easily adapted for other learning tasks where outcome-based learning is not practical.