{"entity":{"id":"oral-targeted-therapy-drug-monitoring","kind":"technology","name":"Blood-level monitoring of oral targeted cancer drugs","aka":["therapeutic drug monitoring of kinase inhibitors","TDM of oral targeted therapies","trough level monitoring","pharmacokinetically guided dosing of targeted therapy"],"tldr":"Cancer tablets such as kinase inhibitors are given at one dose for everyone, though the amount in the blood differs widely between people. A Dutch study of 600 patients measured trough levels and adjusted when they were low, cutting the share of people with too little drug by 39 per cent, but no trial has yet shown that this improves survival.","summary":"What it measures. For many oral targeted drugs, higher blood levels go with better effect, yet the levels reached on the standard dose vary widely between people because of absorption, food, other medicines and how reliably tablets are taken. Monitoring measures the lowest level before the next dose, the trough, against a predefined target.\n\nWhat was shown. A prospective multicentre study in the Netherlands enrolled 600 patients starting one of 24 oral targeted therapies and sampled blood at 4, 8 and 12 weeks and every 12 weeks after. When the trough was below target and side effects allowed, the team checked adherence and drug interactions, moved the dose to be taken with food, split it, or raised it. At the third measurement 25.8 per cent of 426 assessable patients still had low exposure, a 39.0 per cent reduction in the underexposed share compared with historical data. Over the whole study 53.3 per cent had at least one low level, and when an intervention was made it worked in 74.3 per cent of those assessable.\n\nWhere it stands. This is precision of exposure, and it is shown. Whether reaching the target lengthens life or delays progression has not been tested in a randomised trial in the sources OnCo read, and the comparison here is with historical patients rather than a concurrent control.","status":"emerging","asOf":"2026-10-20","links":[{"label":"Therapeutic drug monitoring-based precision dosing of oral targeted therapies in oncology: a prospective multicenter study (Ann Oncol 2022)","url":"https://doi.org/10.1016/j.annonc.2022.06.010"}],"tags":["precision","evidence:insufficient"],"related":["idea-tr1-therapeutic-drug-monitoring-for-oral-tkis"],"cancers":[],"sections":["targeted-therapy","supportive-care"],"technologies":["kinase-inhibitors","pkpd-modelling","fluorouracil-pharmacokinetic-dosing"],"targets":[],"drugs":["imatinib"],"companies":[],"institutions":[],"pathways":[],"terms":["pharmacokinetics","therapeutic-index"],"trials":[],"people":[],"bottlenecks":["b-dose-optimisation"],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"principle":"Plasma trough concentration compared with a target derived from exposure-response analyses, with stepwise interventions when below target.","strengths":["Prospective, multicentre and across 24 drugs","Many corrections need no dose increase: food, timing, interactions, adherence","Cut the share of underexposed patients by 39 per cent against historical data"],"limitations":["No randomised evidence of survival or progression benefit","Compared with historical rather than concurrent controls","Targets are not established for every drug"]},"route":"/technologies/oral-targeted-therapy-drug-monitoring/","neighbours":{"idea":[{"id":"idea-tr1-therapeutic-drug-monitoring-for-oral-tkis","kind":"idea","name":"Measure blood levels of oral targeted drugs and adjust doses to a target range","route":"/ideas/idea-tr1-therapeutic-drug-monitoring-for-oral-tkis/"}],"section":[{"id":"supportive-care","kind":"section","name":"Supportive Care & Survivorship","route":"/fronts/supportive-care/"},{"id":"targeted-therapy","kind":"section","name":"Targeted Therapy","route":"/fronts/targeted-therapy/"}],"technology":[{"id":"fluorouracil-pharmacokinetic-dosing","kind":"technology","name":"Fluorouracil dosing by measured blood level","route":"/technologies/fluorouracil-pharmacokinetic-dosing/"},{"id":"pkpd-modelling","kind":"technology","name":"Pharmacokinetic and pharmacodynamic modelling","route":"/technologies/pkpd-modelling/"},{"id":"kinase-inhibitors","kind":"technology","name":"Small-molecule kinase inhibitors","route":"/technologies/kinase-inhibitors/"}],"drug":[{"id":"imatinib","kind":"drug","name":"Imatinib","route":"/drugs/imatinib/"}],"term":[{"id":"pharmacokinetics","kind":"term","name":"Pharmacokinetics (PK), half-life and exposure","route":"/terms/pharmacokinetics/"},{"id":"therapeutic-index","kind":"term","name":"Therapeutic index (therapeutic window)","route":"/terms/therapeutic-index/"}],"bottleneck":[{"id":"b-dose-optimisation","kind":"bottleneck","name":"Wrong doses","route":"/bottlenecks/b-dose-optimisation/"}]}}