Therapeutic Drug Monitoring in Cancer Chemotherapy

Abstract

For a select number of drugs, proper management of patients includes monitoring serum or plasma concentrations of the drugs and adjusting the doses accordingly - this practice is referred to as therapeutic drug monitoring (TDM). The need for TDM arises when pharmacokinetic variability of drugs is not easily accounted for by common clinical parameters. Many chemotherapeutic drugs have large interindividual variability, yet TDM is not commonplace in chemotherapy management. This review will discuss pharmacokinetics in the context of chemotherapeutic drugs, examine the few instances where TDM is currently used in the field of oncology and propose other drugs where TDM might be useful for dose adjustments in the management of chemotherapy.

Real-Time, Aptamer-Based Tracking of Circulating Therapeutic Agents in Living Animals

“…As reported in the literature (27), drug dosing strategies based on pharmacokinetic models using physiological parameters such as sex, mass or body surface area often fail to capture clinically important inter-and intra-patient variability. This may in part account for the inconsistencies often observed in response to therapy, wherein patients receiving similar doses of doxorubicin, for example, exhibit markedly different toxic and therapeutic responses (12, 28). Accordingly, individualized drug dosing based on therapeutic drug monitoring has led to considerable improvements in patient outcomes, especially for drugs with narrow therapeutic ranges (29).…”

A magnetic anti-cancer compound for magnet-guided delivery and magnetic resonance imaging

“…Secondly, Fe(Salen) particles per se were visualized by MRI, and its accumulation was demonstrated by MRI after drug delivery in the cancer animal model. It has been difficult to determine the appropriate drug doses for cancer chemotherapy 38 , as well as to assure its delivery to the tumor. Drug doses have been determined empirically, using the body surface area index of each patient, at least in the past half-century 39 40 .…”

The Valley of Death in anticancer drug development: a reassessment

“…TDM is normally associated with older cytotoxic drugs, but several newer targeted agents (e.g, imatinib) meet traditional criteria for TDM, spurring calls for its application[64]. Slow acceptance of TDM into clinical practice has prompted some authors to question its very future[65] even though it clearly addresses the current goal of personalized medicine.…”