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Importance of Therapeutic Drug Monitoring for Targeted Therapies

May1,2015 / MaryGarland(https://liferaftgroup.org/author/mgarland/) / DrugTreatment
(https://liferaftgroup.org/category/drugtreatment/),News(https://liferaftgroup.org/category/news/)
Aspersonalizedmedicinehasbecomeanacceptedparadigm,itmaybetimeforoncologiststoexaminepersonalizeddose
levels.

InarecentarticlefromCancerWorld,(http://www.cancerworld.org/Articles/Issues/64/JanuaryFebruary2015/Cutting
Edge/697/Rightpatientrightdrugwrongdose.html)theauthorexploresthevalueoftherapeuticdrugmonitoringforthose
receivingtargetedtherapies.

Therapeuticdrugmonitoring(TDM)istheclinicalpracticeofmeasuringspecificdrugsatdesignatedintervalstomaintaina
constantconcentrationinthepatientsbloodstream,therebyoptimizingindividualdosageregimens.Itistheclinical
laboratorymeasurementofachemicalparameterthat,withappropriatemedicalinterpretation,willdirectlyinfluencedrug
prescribingprocedures.1

TDMhasbeenrecommendedforimatanibtoimproveefficacy,assesscompliance,andevaluatedrugdruginteractions.2
ItcanalsobeanimportanttoolindiscoveringanyinteractionsGISTmedicationsarehavingwithmedicationsbeingtaken
forotherconditions.

AconcentrationofGleevecinthebloodabove1100ng/mLcorrelateswithbetterclinicaloutcomesaccordingtoGeorge
Demetri,MDoftheDanaFarberCancerInstitute.Moreonthistopiccanbefoundhere
(https://liferaftgroup.org/2013/01/imatinibplasmalevelsrevisited/).

Thearticlesuggeststhatpoorresponsetodrugtreatmentmaybetheresultofastandarddosingapproach,whichdoesnot
requireTDM.

TherehasbeenagroundswellofadvocacyforTDMinEurope,wheretheEuropeanJournalofCancerranaseriesof
positionpapersontheissue,oneinparticularthatmentionsimatinibandsunitinibamongothers.Foralinktothisarticle
clickhere(http://www.ejcancer.com/article/S09598049(14)00598X/abstract).

WhataretheroadblockstomorewidespreadTDM?Havingaccesstofacilitiesthatdothetestingisone.Speedof
turnaroundofresultsisanother.Schedulingpatientscanalsobeachallenge,aswellasthecostinvolved.

RegulatorybarriershavealsocontributedtotheinfrequentorderingofTDM.TheFDAin2010warnedNovartisaboutthe
recommendationfortherapeuticdrugmonitoringforimatinib,citingthattherewasalackofsubstantialevidenceor
substantialclinicalexperiencetosupportacorrelationbetweenpatientoutcomeandplasmalevelsofimatinib.

IncreasedevidenceiswarrantedtohaveTDMinwidespreadclinicaluse.

Plasma Level Testing

AstrongadvocateforTDMisSaladaxBiomedical,(http://www.saladax.com/)aUScompanythatoffersassaysforseveral
targeteddrugs.SaladaxoffersPlasmaLeveltesting,forimatanib(Gleevec),apracticetheLifeRaftGrouphassupported.

Plasma/BloodLevelTesting(BLT)isapharmacokineticmethodofdetermininghowmuchimatinib(Gleevec)ispresentina
patientsbloodataspecifictime.Typically,theminimumconcentration(knownastroughlevelorCmin)ismeasuredright
beforetakingthenextdoseofGleevec(ideally2224hoursaftertakingthelastdose).Bymeasuringthisleveldoctorscan
seeifthepatientistakingtheirGleevecasprescribed.
WithvaluableinformationtobeobtainedbytheuseofTDM,morestudiesareclearlycalledfor.Asprogressismadein
adaptingTDMforclinicalpracticeandinadvocacyforitsuse,theLRGwillcontinuetokeepyouposted.

1.TouwDJ,NeefC,ThomsonAH,VinksAA.Costeffectivenessoftherapeuticdrugmonitoring:asystemicreview.Ther
DrugMonit(http://www.ncbi.nlm.nih.gov/pubmed/15665740).200527:1017.

2.Teng,JF,Mabasa,VH,Ensom.Theroleoftherapeuticdrugmonitoringofimatinibinpatientswithchronicmyeloid
leukemiaandmetastaticorunresectablegastrointestinalstromaltumors.TherDrugMonit.
(http://www.ncbi.nlm.nih.gov/pubmed/22215488)2012Feb34(1):8597.

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