Cancer therapy, Toxicity challenges , drug safety, theraputic drug monitoring
Therapeutic drug monitoring (TDM) have been applied most frequently in the cardiovascular, respiratory, neurology, and infectious disease areas because the medications used have both narrow therapeutic indices and marked interindividual variability with clear relationship between concentration and effect. However, Therapeutic drug monitoring is not routinely used for chemotherapy agents till recently, when target concentration or exposure measure such as AUC have been established in clinical practice for the optimization of drug treatment, apart from drugs such as methotrexate and 5-fluorouracil. Several factors including poorly defined concentration-effect relationships limit the use of therapeutic drug monitoring (TDM) for many cancer chemotherapeutic/antineoplastic agents. This is further complicated by cancer being a highly heterogeneous group of diseases, each of which may have a unique concentration-effect relationship for any given drug or drug combination. Defining concentration-effect relationships is also complicated by the fact that cancer is almost always treated with multiple drugs given in combination making the precise definition of the pharmacodynamics of individual agents difficult. Nonetheless, TDM clearly has the potential to improve the clinical use of antineoplastic agents, most of which have very narrow therapeutic indices and highly variable pharmacokinetics. There is also a substantial body of literature demonstrating relationships between systemic exposure to various chemotherapy agents and their toxic or therapeutic effects. Furthermore, in the last decades, relationships between plasma drug concentrations and clinical outcome have been defined for various chemotherapeutic agents. The objective of this contribution is to describe some of the evidence that support the use of TDM in oncology ,while emphasizing the shortcomings and challenges related unless extremely cautioous interpretation and individualized approach is applied. The final take home message is also to propose that TDM may play a critical role in optimizing chemotherapy outcomes if wisely used with continious knowledge based pharmacokinetic-pharmacodynamic research results upplied by multidisciplinary team of professionals.
Cite this paper
Tesfaye H.. (2016) Advances, Possibilities, and Challenges of Anti-Cancer Chemotherapy and the Utilization of Therapeutic Drug Monitoring to Improve Outcomes: State of the Atr. International Journal of Oncology and Cancer Therapy, 1, 12-23