Personalized dosing strategies

Currently, (most) chemotherapeutic agents are dosed on body-surface area, and oral compounds are given in a fixed dose.  Although we know that these strategies are obsolete and not patient-tailored at all (Bins et al, Clin Pharmacol Ther 2014), the lack of good alternatives makes it hard to change daily practice. Nonetheless, nowadays oncologists are aware of the importance of giving the right dose to the right patient, as a clear dose-response relationship exists for most anti-cancer agents (see Mathijssen et al, Nat Rev Clin Oncol 2014).

In this research-part of our group we fully focus on alternative dosing strategies. One example involves the so-called ´phenotyping´ strategy in which the patient is given a ‘probe’ drug, predicting the exposure to the anti-cancer agent in question. This probe-drug is metabolized largely in a comparable way as the anti-cancer drug, but is non-toxic, easily measurable, cheap, and capable to adjust for both genetic and environmental (i.e. lifestyle) factors.
Another new dosing strategy (within oncology) involves therapeutic drug monitoring (TDM), in which the systemic drug concentration is measured at several time points, and the dose is adjusted based on the measured levels.

Recently, the feasibility of TDM with sunitinib and pazopanib was explored in two clinical trials, and currently we measure cabazitaxel drug-concentrations for the CAINTA-study (a TDM-study which is ongoing in Germany/Switserland/Austria; PI: dr. M. Joerger) .

  bbc news hoestdrank

 

Media-attention for the dextromethorphan phenotyping test to predict endoxifen exposure