Therapeutic Drug Monitoring in Oncology: The key to individualised ...

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Is Dose Important in Cancer Chemotherapy? • Yes – for toxicity • Yes for efficacy????? • Inter-patient variability • Bonadonna: Reduced survival in breast cancer patients receiving < 85% of target dose in CMF regimen Bonadonna etal, N Engl J Med (1995), 332, 901
How Accurate/Relevant is BSA-Based Dosing ? • Use of BSA arises from interspecies dosing (animals to humans) in Phase 1 studies. • BSA does not correlate well to drug clearance plasma or tumour levels. • Errors in BSA calculation (DuBois and DuBois, Arch. Int.Med 1916 : 17 :863-71) • No basis for physiological scaling within species
Page 1 and 2: Therapeutic Drug Monitoring in Onco
Page 3 and 4: Cancer Chemotherapy • High toxici
Page 5 and 6: Pharmacokinetics • Describes the
Page 7 and 8: Therapeutic Drug Monitoring (TDM)
Page 9 and 10: Requirements for TDM • No direct
Page 11 and 12: TDM : Procedure • Take sample: -
Page 13: TDM- “The Old Way” • Give sta
Page 17 and 18: Problems with TDM in Oncology • P
Page 19: Examples of TDM (2) 5-Fluorouracil
Page 22 and 23: Example of TDM (3) Mercaptopurine
Page 24 and 25: Mercaptopurine Catabolism Liver GI
Page 26 and 27: PK-PD Relationships in Cancer Chemo
Page 29 and 30: Carboplatin dose for manageable hae
Page 35 and 36: Carboplatin Continuous Infusion PK-
Page 37 and 38: Bayesian Theory Rev. Thomas Bayes,
Page 39 and 40: Bayesian Adaptive Dosing Prospectiv

Therapeutic Drug Monitoring in Oncology: The key to individualised ...

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