Individualized dosing of oral targeted therapies in oncology is crucial in the era of precision medicine.

Individualized dosing of oral targeted therapies in oncology is crucial in the era of precision medicine.

Publication date: Jun 07, 2019

While in the era of precision medicine, the right drug for each patient is selected based on molecular tumor characteristics, most novel oral targeted anticancer agents are still being administered using a one-size-fits-all fixed dosing approach. In this review, we discuss the scientific evidence for dose individualization of oral targeted therapies in oncology, based on therapeutic drug monitoring (TDM).

Based on literature search and our own experiences, seven criteria for drugs to be suitable candidates for TDM will be addressed: (1) absence of an easily measurable biomarker for drug effect; (2) long-term therapy; (3) availability of a validated sensitive bioanalytical method; (4) significant variability in pharmacokinetic exposure; (5) narrow therapeutic range; (6) defined and consistent exposure-response relationships; (7) feasible dose-adaptation strategies.

All of these requirements are met for most oral targeted therapies in oncology. Also, prospective studies have already shown TDM to be feasible for imatinib, pazopanib, sunitinib, everolimus, and endoxifen.

In order to realize the full potential of personalized medicine in oncology, patients should not only be treated with the right drug, but also at the right dose. TDM could be a suitable tool to achieve this.

Groenland, S.L., Mathijssen, R.H.J., Beijnen, J.H., Huitema, A.D.R., and Steeghs, N. Individualized dosing of oral targeted therapies in oncology is crucial in the era of precision medicine. 04763. 2019 Eur J Clin Pharmacol.

Concepts Keywords
Biomarker Molecular tumor
Everolimus Medicine
Imatinib Health
Oncology Clinical medicine
Pharmacokinetic Pharmacokinetics
Precision Medicine Pharmacy
Sunitinib Cancer treatments
Targeted Therapies Antineoplastic drugs
TDM Indoles
Therapeutic Range Sunitinib
Tumor Therapeutic drug monitoring
Targeted therapy
Precision medicine

Semantics

Type Source Name
drug DRUGBANK Everolimus
drug DRUGBANK Sunitinib
drug DRUGBANK Pazopanib
drug DRUGBANK Imatinib
gene UNIPROT RNMT
gene UNIPROT MET
gene UNIPROT SLTM
drug DRUGBANK Methionine
disease MESH tumor
gene UNIPROT ERAL1
gene UNIPROT ESR1

Original Article

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