[Pharmacokinetics and therapeutic drug monitoring of anticancer agents]

Abstract

Treatment individualisation, an old concept renovated by the progress of analytical techniques and the advent of pharmacogenetics, aims at optimizing the usage of existing drugs by adjusting the nature and dose of anticancer agents to each patient, based on genetic, physiological and pathological criteria, on tumour nature, on associated drugs or previous treatment lines, on treatment efficacy and toxicity or on patient's exposure to the active drug form. This article exposes the pre-requisites and clinical trials necessary to demonstrate the usefulness of therapeutic drug monitoring (TDM) for drugs in general and anticancer agents in particular. It also presents the different TDM approaches used in oncology and reviews the current situation of anticancer drugs' TDM. When TDM cannot be expected to optimize efficacy, it may at least contribute to secure high dose regimens in intensification protocols. TDM in oncology is a discipline in progress. Proofs of efficacy are both scarce are difficult to obtain. However, taking this limitation into account and using the benefits of technical progress could lead to better cognitive research on the predictive response factors for a larger number of anticancer agents in the future. When the usefulness of TDM has been clinically demonstrated or strongly suggested, it is essential that as many patients as possible benefit from it. This "technological transfer" is a continuous process that requires periodical reviews of research results for TDM specialists and clinicians.