termsTerm

Dose reduction, interruption and discontinuation

aka dose reduction, dose reductions, dose-reduction, dose reduced, dose interruption, dose interruptions, dose delay, dose delays, treatment delay, dose hold, hold treatment, dose modification, dose modifications, dose adjustment, dose adjustments, discontinuation, discontinuations, discontinued, treatment discontinuation, discontinuation rate, discontinuation due to adverse events, permanent discontinuation, stopped treatment, treatment cessation, relative dose intensity, RDI, adherence, non-adherence, compliance, real-world dosing, starting dose

The everyday tools for living with side effects: pausing a drug until a problem settles (interruption), restarting at a lower dose (reduction), or stopping it for good (discontinuation). How often patients need these is a key measure of whether a dose was set right.

Labels specify dose modification rules by toxicity grade; in practice 30-60% of patients on many oral targeted drugs need a reduction, and discontinuation for adverse events (typically 5-20% in trials, higher in real-world older populations) directly reduces benefit. Relative dose intensity below 85% is associated with worse outcomes for curative chemotherapy, whereas for targeted drugs lower doses often work as well (Project Optimus's rationale). Adherence to daily pills over years (endocrine therapy, imatinib) is a hidden determinant of efficacy. Trials report dose reductions and discontinuations alongside grade 3-4 events as the clearest summary of tolerability.

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CTCAE toxicity grading (grade 3-4 adverse events)Febrile neutropenia Hand-foot syndrome and hand-foot skin reaction Hepatotoxicity (liver enzyme elevation)Hyperglycaemia (PI3K/AKT inhibitor class effect)Immune-mediated colitis and diarrhoea Maximum tolerated dose (MTD)Neutropenia Ocular toxicity (keratopathy, blurred vision)Performance status (ECOG, Karnofsky)Peripheral neuropathy (chemotherapy-induced)Pharmacokinetics (PK), half-life and exposure Project Optimus Quality of life and patient-reported outcomes (QoL, PRO)Rash and skin toxicity (acneiform rash, paronychia)Regimen and cycles Therapeutic index (therapeutic window)