Model-informed individual dosing with drug-level monitoring for every oral cancer drug
People differ several-fold in how they absorb and clear cancer pills. Measure blood levels and adjust each person's dose, as is routine for some antibiotics and transplant drugs.
Exposure to oral kinase inhibitors and endocrine agents varies widely between patients and correlates with both toxicity and efficacy (imatinib, abiraterone, tamoxifen metabolites, sunitinib). Therapeutic drug monitoring is standard in other fields but rare in oncology. The proposal is a programme defining exposure targets for the top 30 oral anticancer drugs, a low-cost assay network, and model-informed precision dosing software integrated into prescribing, tested in randomised trials against fixed dosing.
- 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.
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not linked directly; found by shared links- IdeaMeasure blood levels of oral targeted drugs and adjust doses to a target range
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