Measure blood levels of oral targeted drugs and adjust doses to a target range
Blood levels of oral cancer pills vary several-fold between people on the same dose, so some are under-treated and others poisoned. Checking levels and adjusting the dose, as is routine for some antibiotics, could fix both.
Therapeutic drug monitoring (TDM) for oral kinase inhibitors and hormonal agents with established exposure-response relationships and high inter-patient variability (imatinib, sunitinib, pazopanib, abiraterone, tamoxifen via endoxifen, and newer agents), with dose adjustment to a target trough. Dutch multicentre TDM studies have shown feasibility and increased target attainment; outcome-powered randomised trials are lacking.
- Wrong doses · Most drug doses were chosen as the highest a person can tolerate, which is often more than they need.
- 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.
Pages like this
not linked directly; found by shared links- IdeaModel-informed individual dosing with drug-level monitoring for every oral cancer drug
Shares Imatinib, Endocrine therapy (SERMs, AIs, SERDs), Wrong doses, Toxicity and quality of life are undervalued.
- IdeaDose adjustments driven by patients' own symptom reports, tested against clinician judgement
Shares Wrong doses, Toxicity and quality of life are undervalued, Small-molecule kinase inhibitors.
- IdeaReduce the dose once the cancer responds: response-adapted de-escalation trials
Shares Imatinib, Wrong doses, Toxicity and quality of life are undervalued, Small-molecule kinase inhibitors.
- IdeaAnalyse and dose by sex: women get more toxicity from many cancer drugs at the same dose
Shares Wrong doses, Toxicity and quality of life are undervalued, Small-molecule kinase inhibitors.
- IdeaRandomise at least two doses in phase 2 before any pivotal trial
Shares Wrong doses, Toxicity and quality of life are undervalued, Small-molecule kinase inhibitors.
- IdeaPublicly funded dose-reduction trials of expensive approved drugs
Shares Imatinib, Wrong doses, Small-molecule kinase inhibitors.
- IdeaReal-world dose intensity and toxicity monitoring to revise labelled doses
Shares Wrong doses, Toxicity and quality of life are undervalued.
- IdeaFactorial dose finding for drug combinations instead of full dose of everything