Extended-interval immunotherapy: give checkpoint inhibitors every 8-12 weeks once stable
Immunotherapy antibodies stay active in the body for weeks, yet are often given every two or three weeks. After a few months, spacing doses out to every two or three months might work as well, with fewer hospital visits and much lower cost.
Non-inferiority trials randomising patients with response or stable disease after 3-6 months of PD-1/PD-L1 blockade to extended-interval dosing (e.g., every 8-12 weeks, PK-guided) versus standard intervals, with PFS or TTF non-inferiority and cumulative dose, cost and toxicity as secondaries. Receptor occupancy studies show saturation at exposures far below label; PK-guided interval extension has been piloted.
- Wrong doses · Most drug doses were chosen as the highest a person can tolerate, which is often more than they need.
- Prices and value · New cancer drugs routinely cost over $150,000 a year, often for months of benefit. Systems cannot afford them and patients go bankrupt.
- Toxicity and quality of life are undervalued · Trials measure how long people live, not how they live. Side-effects are under-reported and under-treated.
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