Tailor-made chemotherapy for cancer patients

Dosages of anticancer agents are usually calculated from a uniform standard-the body surface area (BSA). Although the BSA is proportionate to many physiological functions, it is however only partially related to the overall drug clearance. Consequently, a wide variability in drug exposure and drug concentrations can be found between patients, by which some experience little toxicity, while others may show severe toxic symptoms. It seems clear that monitoring of plasma drug concentrations can be a useful tool to further optimize current cancer chemotherapy. The problem that pharmacokinetic parameters are usually generated from concentration-time profiles obtained after multiple venepunctures can be reduced by applying limited sampling models (LSM). Other tailor-made dosing strategies include the Calvert formula for carboplatin dosing and strategies based on the characteristics of the individual patient. It can be concluded that the determination of pharmacokinetic parameters and adjustment of the drug dose in each patient to a predefined 'target' value with an optimal therapeutic outcome, could contribute substantially to improvement of current chemotherapeutic treatment.