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INFORMATION FOR
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Blood Level Testing
in the Management of CML

Blood level testing, a form of therapeutic drug monitoring (TDM), involves measuring a drug's concentration in a patient's blood and then using that information to individualize the drug's dosage or schedule for that patient.1

Therapeutic drug monitoring is used to help

  •  Maximize a drug's therapeutic effect1
  •  Minimize toxicity1
  •  Assess patient adherence2

Therapeutic drug monitoring is generally employed with drugs that

  •  Exhibit considerable intra- or interpatient variability1
  •  Have an established relationship between concentration and  pharmacological effects1
  •  Lack a wide therapeutic index1
  •  Can be measured with a precise, accurate drug assay1

The Expanding Role of Blood Level Testing in Oncology
Over the past 15 years, therapeutic drug monitoring has begun to play a greater role in oncology.1 A key reason for this is the availability of a growing number of oral anticancer agents.3 It is estimated that up to 30% of new oncology drugs are being developed for oral administration-and this percentage is expected to substantially increase in the near future.4

Therapeutic drug monitoring is critical for oral oncology drugs, because oral agents are inherently more susceptible than IV agents to intra- and interpatient variability in absorption, bioavailability, and adherence.3,4 Subtherapeutic drug concentrations have been identified as the most important concern relating to the oral administration of anticancer agents.4

Blood Level Testing of Tyrosine Kinase Inhibitors (TKIs)
Although TKI treatment has been shown to be an effective treatment for CML, individual patient responses to therapy vary. Blood level testing may help to illuminate causes of inadequate or slow responses to treatment.

Studies of TKI treatment in CML and in gastrointestinal stromal tumors (GISTs) have found a correlation between low drug plasma levels and inadequate response to treatment.5,6

Suboptimal TKI plasma levels may be due to patient nonadherence, or to other factors, including7

  •  Host differences in drug absorption/metabolism
  •  Comorbidities
  •  Drug-drug interactions

Establishing a baseline blood level 30 to 90 days after the initiation of therapy can provide a reference point for future measurements and may help optimize treatment when evaluating response.

  Enroll your patients in the Blood Level Testing Program

  1. Alnaim L. Therapeutic drug monitoring of cancer chemotherapy. J Oncol Pharm Practice. 2007;13(4):207-221.
  2. Hugen PWH, Burger DM, Aarnoutse RE, et al. Therapeutic drug monitoring of HIV-protease inhibitors to assess noncompliance. Ther Drug Monitor. 2002;24(5):579-587.
  3. McLeod HL, Evans W. Oral cancer chemotherapy: the promise and the pitfalls. Clin Cancer Res. 1999;5(10):2669-2671.
  4. Kuppens IEL, Breedveld P, Beijnen JH, Schellens JHM. Modulation of oral drug bioavailabilty: from preclinical mechanism to therapeutic application. Cancer Investig. 2005;23(5):443-464.
  5. Larson RA, Druker BJ, Guilhot F, et al; for IRIS (International Randomized Interferon vs STI571) Study Group. Imatinib pharmacokinetics and its correlation with response and safety in chronic-phase chronic myeloid leukemia: a subanalysis of the IRIS study. Blood. 2008;111(8):4022-4028.
  6. Demetri GD. Therapeutic monitoring of drug plasma concentrations and improved outcomes in GIST. Clin Adv Hem Oncol. 2009;7(2)(suppl 4):6-7.
  7. Egorin MJ. Promises and pitfalls of oral cancer chemotherapy. Clin Adv Hem Oncol. 2009;7(2)(suppl 4):8-10.

 

 

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