TDM of anticancer drugs: We can work it out!

04/03/23 • 43 min

This episode is about the TDM of anticancer therapies, a space where there is a sense of frustration about body-size based dosing, but while concentration-based promises to make a difference to clinical care, it still feels that progress has been less than satisfying. Florian opens the episode with an ode to oncologists, a song from the heart to say: ‘We can work it out!’

Our guests today are Dirk Jan Moes and Vikram Gota, both very active in ‘working things out’ in the space, in different corners of the world. We unpack the many challenges but arrive at the conclusion that for TDM in oncology, ‘the future is bright!’

In this episode we hear about:

Older anticancer drugs: can we do new tricks with old drugs, or have we missed the boat?
The importance of the drug label and reimbursement for clinical implementation
Anticancer drugs and clinical contexts where microsampling can enhance implementation
Financial toxicity: should we be styling ourselves as financial toxicologists!?
Progress in the paediatric space
Combining concentration measurement with pharmacogenetics, biomarkers and model informed precision dosing
Buy-in: the importance of clinical champions and education initiatives

To join IATDMCT, visit https://www.iatdmct.org/member-join

Subscribe to Eight Drugs a Week on your preferred podcast platform.

About our guests:

Dirk Jan Moes is a Laboratory Hospital Pharmacist and Clinical Pharmacologist, Assistant Professor of Applied Clinical Pharmacometrics at the Department of Clinical Pharmacy and Toxicology at the Leiden University Medical Centre in The Netherlands.

Vikram Gota is an MD, Professor & Officer-in-charge of the Department of Clinical Pharmacology at the Advanced Centre for Treatment Research & Education in Cancer at the Tate Memorial Centre in Mumbai, India.

In this episode we hear about:

Older anticancer drugs: can we do new tricks with old drugs, or have we missed the boat?
The importance of the drug label and reimbursement for clinical implementation
Anticancer drugs and clinical contexts where microsampling can enhance implementation
Financial toxicity: should we be styling ourselves as financial toxicologists!?
Progress in the paediatric space
Combining concentration measurement with pharmacogenetics, biomarkers and model informed precision dosing
Buy-in: the importance of clinical champions and education initiatives

To join IATDMCT, visit https://www.iatdmct.org/member-join

Subscribe to Eight Drugs a Week on your preferred podcast platform.

About our guests:

Previous Episode

TDM of Biologics: “Tomorrow never knows”

This episode is about the TDM of biologics, a therapeutic class that only really emerged into widespread use about 20 years ago – but that as a class represents a breakthrough for many therapeutic challenges. This area has some differences compared to traditional TDM of small molecules, and although it’s established for some biologics, the role for TDM in the space is, in a sense, still being determined. Florian has consequently titled this episode ‘Tomorrow never knows’ – a great song and a fitting title.

Our guests today are Annick de Vries and Murray Barclay, and both have made important contributions in the space. Once again, our guests coincided on their favourite Beatle – one that we haven’t heard mentioned in previous episodes!

In this episode we hear about:

the differences between small molecule drugs and biologics, and the implications this has for TDM of the latter
how disease severity may influence pharmacodynamics, and ultimately how we might ultimately select treatment targets despite challenges in obtaining measurements of disease activity
anti-drug antibodies and the role of TDM there
disease dependent clearance and whether concentrations of biologics might possibly be a marker of disease activity

To join IATDMCT, visit https://www.iatdmct.org/member-join

Subscribe to Eight Drugs a Week on your preferred podcast platform.

About our guests:

Annick de Vries is director of Diagnostic Services at Sanquin in Amsterdam, The Netherlands. Sanquin is a not-for-profit that provides blood products nationwide, but also develop specialized pharmaceutical products and provide diagnostic services. She is the current chair of the IATDMCT Biologics Committee.

Murray Barclay is a clinical pharmacologist and a gastroenterologist at Christchurch Hospital in New Zealand, and a Clinical Professor at the University of Otago. Murray was the previous chair of the Biologics Committee.

Next Episode

TDM of antiretroviral drugs: The continuing story (of Bungalow Bill)…

This episode is about the TDM of antiretroviral drugs, an area with a boom in research output in the late 90s and early 2000s, generating enough randomized controls trials for a substantial systematic Cochrane review on the topic (a rare thing for TDM research!). It’s an ever-evolving space, where drug regimens are continually refined with newer drug options with fewer adverse effects. However, we have learned a lot through concentration monitoring, and TDM continues to be very useful in optimizing treatment. As our title suggests, this is a continuing story.

Our guests today are Natella Rakhmanina and Dario Cattaneo, who have been involved in the story since the beginning but from different perspectives, Natella as a paediatric infectious diseases specialist and Dario as a clinical pharmacologist. We cover the history, discuss the role that TDM has today and consider where things are headed.

In this episode we hear about: • The usefulness and limitations of using TDM to monitor adherence. • Diverse niche patient scenarios where TDM can be very helpful, which are not at all uncommon. • Interesting challenges where TDM can be helpful, some that are particular to paediatric patients, and others to elderly HIV patients. • Learnings from TDM for long-acting drugs in psychiatry, and the implications for novel depot antiretroviral formulations. • Drug interaction attributable to antiretrovirals, and those that affect them. • Why, despite viral monitoring, TDM for antiretrovirals can still be very useful. • What Paxlovid tastes like.

Eight Drugs a Week is supported by the International Association of Therapeutic Drug Monitoring and Clinical Toxicology (IATDMCT). The personal views of the hosts and guests do not necessarily reflect the position of the Association. To join IATDMCT, visit https://www.iatdmct.org/member-join Subscribe to Eight Drugs a Week on your preferred podcast platform. About our guests:

Natella Rakhmanina is a Professor at the Department of Paediatrics, School of Medicine and Health Sciences of The George Washington University. She is also director of HIV Services of the Division of Infectious Diseases at the Children’s National Hospital in Washington.

Dario Cattaneo is currently the President of the IATDMCT. He is a clinical pharmacologist at Luigi Sacco University Hospital in Milan and an Adjunct Professor at the University of Milan, Italy.