What is the most used technique to calculate chemotherapy dosage? What are emerging techniques, including their pros and cons? Can anybody give me a pointer to reference documents?
Many chemotherapy (cytotoxic) drugs are prescribed proportional to calculated body surface area, using formulae that are decades old and arguably inaccurate. Some are prescribed at a fixed or capped dose, and some on the basis of pharmacokinetics (eg carboplatin based on predicted AUC). Doses are usually selected on the basis of maximum tolerated dose from earlier clinical trials. There is a substantial literature on this, including good evidence that we often underdose patients for a range of reasons.
Newer agents with different mechanisms of action might not have a defined MTD, or the optimal or biologically effective dose might be different. Drugs such as axitinib, for example, often are titrated until a certain toxicity (hypertension in this case) is achieved, which predicts both therapeutic drug levels for that patient and also correlates with efficacy.
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