Personalized pharmacotherapy in oncology: Application of pharmacokinetic-pharmacodynamic criteria.
Por:
Porta-Oltra, B and Merino-Sanjuan, M
Publicada:
22 dic 2021
Ahead of Print:
22 dic 2021
Resumen:
OBJECTIVE: Indication of personalized pharmacotherapy in oncologic patients is based on the selection of the optimal treatment (drugs, dosing, routes and methods of administration and duration) and on the most appropriate dosing method to achieve maximum antineoplastic efficacy, expressed in terms of remission or relapse-free time and acceptable toxicity for the patients. The aim of this study was to explore the contribution of therapeutic monitoring of plasma concentrations and of the application of the pharmacokinetic and pharmacodynamic information available for some widely used drugs to therapeutic personalization to the care of oncologic patients. METHOD: A complete non-systematic literature review was carried out of the pharmacokinetic and pharmacodynamic properties of antineoplastic agents, as well as of the results of their use in clinical practice. The search for high quality articles included primary and secondary bibliographic sources. The benefits of therapeutic monitoring were evaluated for parenteral cytotoxic rugs, oral antineoplastic drugs, monoclonal antibodies and other biological therapies used in clinical practice. RESULTS: Therapeutic personalization of antineoplastic drugs based on therapeutic monitoring of plasma concentrations together with the information provided by pharmacokinetic-pharmacodynamic models makes it possible to reduce toxicity and increase the effectiveness of treatment. When personalized treatment is established with high-dose methotrexate in patients with osteosarcoma, target maximum concentrations are reached in 70% of the cycles (49% when fixed doses are used). When 5-fluorouracil is used in patients with colorectal cancer, the response rate is 33.7% (18.3% with fixed doses). Similar benefit rates are obtained with asparaginase, busulfan, oral antineoplastics and monoclonal antibodies. CONCLUSIONS: Due to the narrow therapeutic range of antineoplastic drugs and the highly variable clinical response they elicit, both in terms of effectiveness and safety, the monitoring of their plasma concentrations and the application of pharmacokinetic and pharmacodynamic principles and models constitute feasible and promising tools in the personalization of oncologic treatment.
Filiaciones:
:
Hosp Univ Dr Peset, Serv Farm, Avda Gaspar Aguilar 90, Valencia 46017, Spain
:
Univ Valencia, Dept Farm & Tecnol Farmaceut & Parasitol, Valencia, Spain
Univ Politecn Valencia, Univ Valencia, Inst Interuniv Invest Reconocimiento Mol & Desarr, Valencia, Spain
Open Access
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