TY  - JOUR
A1  - Mueller-Schoell, Anna
A1  - Groenland, Stefanie L.
A1  - Scherf-Clavel, Oliver
A1  - van Dyk, Madele
A1  - Huisinga, Wilhelm
A1  - Michelet, Robin
A1  - Jaehde, Ulrich
A1  - Steeghs, Neeltje
A1  - Huitema, Alwin D. R.
A1  - Kloft, Charlotte
T1  - Therapeutic drug monitoring of oral targeted antineoplastic drugs
JF  - European journal of clinical pharmacology
N2  - Purpose This review provides an overview of the current challenges in oral targeted antineoplastic drug (OAD) dosing and outlines the unexploited value of therapeutic drug monitoring (TDM). Factors influencing the pharmacokinetic exposure in OAD therapy are depicted together with an overview of different TDM approaches. Finally, current evidence for TDM for all approved OADs is reviewed. Methods A comprehensive literature search (covering literature published until April 2020), including primary and secondary scientific literature on pharmacokinetics and dose individualisation strategies for OADs, together with US FDA Clinical Pharmacology and Biopharmaceutics Reviews and the Committee for Medicinal Products for Human Use European Public Assessment Reports was conducted. Results OADs are highly potent drugs, which have substantially changed treatment options for cancer patients. Nevertheless, high pharmacokinetic variability and low treatment adherence are risk factors for treatment failure. TDM is a powerful tool to individualise drug dosing, ensure drug concentrations within the therapeutic window and increase treatment success rates. After reviewing the literature for 71 approved OADs, we show that exposure-response and/or exposure-toxicity relationships have been established for the majority. Moreover, TDM has been proven to be feasible for individualised dosing of abiraterone, everolimus, imatinib, pazopanib, sunitinib and tamoxifen in prospective studies. There is a lack of experience in how to best implement TDM as part of clinical routine in OAD cancer therapy. Conclusion Sub-therapeutic concentrations and severe adverse events are current challenges in OAD treatment, which can both be addressed by the application of TDM-guided dosing, ensuring concentrations within the therapeutic window.
KW  - targeted antineoplastic drugs
KW  - tyrosine kinase inhibitors
KW  - therapeutic
KW  - drug monitoring
KW  - oral anticancer drugs
KW  - personalised medicine
Y1  - 2020
U6  - https://doi.org/10.1007/s00228-020-03014-8
SN  - 0031-6970
SN  - 1432-1041
VL  - 77
IS  - 4
SP  - 441
EP  - 464
PB  - Springer
CY  - Heidelberg
ER  - 
TY  - JOUR
A1  - Henrich, Andrea
A1  - Joerger, Markus
A1  - Kraff, Stefanie
A1  - Jaehde, Ulrich
A1  - Huisinga, Wilhelm
A1  - Kloft, Charlotte
A1  - Parra-Guillen, Zinnia Patricia
T1  - Semimechanistic Bone Marrow Exhaustion Pharmacokinetic/Pharmacodynamic Model for Chemotherapy-Induced Cumulative Neutropenia
JF  - Journal of Pharmacology and Experimental Therapeutics
N2  - Paclitaxel is a commonly used cytotoxic anticancer drug with potentially life-threatening toxicity at therapeutic doses and high interindividual pharmacokinetic variability. Thus, drug and effect monitoring is indicated to control dose-limiting neutropenia. Joerger et al. (2016) developed a dose individualization algorithm based on a pharmacokinetic (PK)/pharmacodynamic (PD) model describing paclitaxel and neutrophil concentrations. Furthermore, the algorithm was prospectively compared in a clinical trial against standard dosing (Central European Society for Anticancer Drug Research Study of Paclitaxel Therapeutic Drug Monitoring; 365 patients, 720 cycles) but did not substantially improve neutropenia. This might be caused by misspecifications in the PK/PD model underlying the algorithm, especially without consideration of the observed cumulative pattern of neutropenia or the platinum-based combination therapy, both impacting neutropenia. This work aimed to externally evaluate the original PK/PD model for potential misspecifications and to refine the PK/PD model while considering the cumulative neutropenia pattern and the combination therapy. An underprediction was observed for the PK (658 samples), the PK parameters, and these parameters were re-estimated using the original estimates as prior information. Neutrophil concentrations (3274 samples) were over-predicted by the PK/PD model, especially for later treatment cycles when the cumulative pattern aggravated neutropenia. Three different modeling approaches (two from the literature and one newly developed) were investigated. The newly developed model, which implemented the bone marrow hypothesis semiphysiologically, was superior. This model further included an additive effect for toxicity of carboplatin combination therapy. Overall, a physiologically plausible PK/PD model was developed that can be used for dose adaptation simulations and prospective studies to further improve paclitaxel/ carboplatin combination therapy.
Y1  - 2017
U6  - https://doi.org/10.1124/jpet.117.240309
SN  - 0022-3565
SN  - 1521-0103
VL  - 362
IS  - 2
SP  - 347
EP  - 358
PB  - American Society for Pharmacology and Experimental Therapeutics
CY  - Bethesda
ER  -