Nuances to precision dosing strategies of targeted cancer medicines

Pharmacol Res Perspect. 2020 Aug;8(4):e00625. doi: 10.1002/prp2.625.

Abstract

Selecting the dose of a targeted cancer medicine that is most appropriate for a specific individual is a rational approach to maximize therapeutic outcomes and minimize toxicity. There are many different options for optimizing the dose of targeted cancer medicines and the purpose of this review is to provide a comprehensive comparison of the main options explored in prospective studies. Precision initial dose selection of targeted cancer therapies has been minimally explored to date; however, concentration, toxicity, and therapeutic outcome markers are used to guide on-therapy dose adaption of targeted cancer therapies across several medicines and cancers. While a specific concentration, toxicity, or therapeutic outcome marker commonly dominates an investigated precision on-therapy dose adaption strategy, greater attention to simultaneously account for exposure, toxicity, therapeutic outcomes, disease status, time since treatment initiation and patient preferences are required for optimal patient outcomes. To enable successful implementation of precision dosing strategies for targeted cancer medicines into clinical practice, future prospective studies aiming to develop strategies should consider these elements in their design.

Keywords: initial dose selection; on-therapy dose adaptation; precision dosing; prospective studies; targeted cancer medicines.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Antineoplastic Agents / administration & dosage*
  • Antineoplastic Agents / adverse effects
  • Dose-Response Relationship, Drug
  • Humans
  • Molecular Targeted Therapy*
  • Neoplasms / drug therapy*
  • Precision Medicine
  • Treatment Outcome

Substances

  • Antineoplastic Agents