We have read with interest the recent article by Verheijen and colleagues (1) reporting the feasibility of the individualization of pazopanib dosing, based on therapeutic drug monitoring of steady-state trough plasma concentrations (Css trough). The authors should be congratulated for this effort to demonstrate the benefits of therapeutic drug monitoring of multikinase inhibitors in cancer patients, a critical and underestimated issue for personalized medicine in medical oncology (2).
This approach is particularly promising in the context of suboptimal plasma exposure, as recently observed in patients with gastrectomy, in whom decreased pazopanib absorption resulted in low Css trough and poor progression-free survival (3).
However, in patients without known factors favouring altered absorption (such as a past history of gastrectomy or the concomitant intake of proton pump inhibitors or anti-H2 agents), we wonder why the investigators have chosen a once-daily regimen for...
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