OnCo
ideasIdea

Test flat versus weight-based dosing of antibodies, and use dose banding to cut waste

Many antibody drugs moved from doses based on body weight to one fixed dose for everyone, which is convenient but means lighter patients get relatively more drug. Trials comparing the two, plus rounding doses to standard vial sizes, could keep effectiveness while cutting cost and waste.

Randomised or PK-bridging comparisons of flat versus weight-based (or weight-banded) dosing for monoclonal antibodies and ADCs where flat dosing was adopted on modelling alone; pharmacy dose-banding and vial sharing implemented as policy where exposure equivalence is shown. Payers fund the trials; savings are large because these agents dominate oncology drug spend.

Hypothesis
Weight-based or banded dosing will be non-inferior to flat dosing for efficacy in most agents studied while reducing drug consumption by 10-25 percent in lighter patients and reducing toxicity for ADCs where exposure drives adverse events.
Rationale
Flat dosing of checkpoint inhibitors was justified by PK modelling, not by outcome trials; for ADCs, exposure-related toxicities (neuropathy, interstitial lung disease, ocular events) argue for tighter exposure control.
What would test it
Two randomised PK-and-outcome trials, one checkpoint inhibitor and one ADC, comparing flat with weight-banded dosing, with tolerability and cost as key secondaries.
Maturity
early clinical
Who has to act
payer
Cost to try
Medium ($1M to $50M)
Years to first evidence
3
Bottlenecks it attacks
  • 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.

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