Role of TDM-Based Dose Adjustments For AC/T Regimen Drugs Used In Breast Carcinoma
Abstract
Breast cancer, a prevalent and significant health issue among women, is influenced by genetic, environmental, and lifestyle factors. Treatment often involves the AC/T regimen (Adriamycin, Cyclophosphamide, and Paclitaxel), which presents dosage challenges due to toxicity and therapeutic window limitations. This review focuses on the role of Therapeutic Drug Monitoring (TDM) in optimizing AC/T regimen doses to enhance efficacy and reduce side effects. TDM's impact on improving clinical outcomes is discussed, especially with targeted therapies like tyrosine kinase inhibitors and immunosuppressants. Adriamycin's DNA intercalation, Cyclophosphamide’s DNA alkylation, and Paclitaxel’s microtubule stabilization illustrate varied mechanisms of action that benefit from TDM for dose personalization. This analysis highlights TDM's potential in reducing adverse effects while maximizing therapeutic impact in breast cancer treatment.
References
Obeagu EI, Babar Q, Vincent CC, et al. Therapeutic targets in breast cancer signaling: a review. J Pharm Res Int. 2021;33:82–99.
Aizaz M, Khan M, Khan FI, et al. Burden of breast cancer: developing countries perspective. Int J Innov Appl Res. 2023;11:31–7.
Ibekwe AM, Obeagu EI, Ibekwe CE, et al. Challenges of exclusive breastfeeding among working class women in a teaching hospital South East, Nigeria. J Pharm Res Int. 2022;34:1.
Sun YS, Zhao Z, Yang ZN, et al. Risk factors and preventions of breast cancer. Int J Biol Sci. 2017;13:1387–97.
Sinha T. Tumors: benign and malignant. Cancer Ther Oncol Int J. 2018;10:555790.
Edward U, Obeagu EI, Okorie HM, et al. Studies of serum calcium, inorganic phosphate, and magnesium levels in lactating mothers in Owerri. J Pharm Res Int. 2021;33:209–16.
Obeagu EI, Ahmed YA, Obeagu GU, et al. Biomarkers of breast cancer: overview. Int J Curr Res Biol Med. 2023;8:8–16.
Iatrakis G, Zervoudis S. Epidemiology of ductal carcinoma in situ. Chirurgia (Romania). 2021;116(5 Suppl):S15–S21.
Jagsi R, Mason G, Overmoyer BA, et al. Inflammatory breast cancer defined: proposed common diagnostic criteria to guide treatment and research. Breast Cancer Res Treat. 2022;192:235–43.
Pedersen RN, Esen BO, Mellemkjær L, et al. The incidence of breast cancer recurrence 10-32 years after primary diagnosis. J Natl Cancer Inst. 2022;114:391–99.
Xia C, Dong X, Li H, et al. Cancer statistics in China and the United States, 2022: profiles, trends, and determinants. Chin Med J (Engl). 2022;135:584–90.
Mahdavi M, Nassiri M, Kooshyar MM, et al. Hereditary breast cancer; genetic penetrance and current status with BRCA. J Cell Physiol. 2019;234:5741–50.
Liu H, Shi S, Gao J, et al. Analysis of risk factors associated with breast cancer in women: a systematic review and meta-analysis. Transl Cancer Res. 2022;11:1344–53.
Heer E, Ruan Y, Mealey N, et al. The incidence of breast cancer in Canada 1971-2015: trends in screening-eligible and young-onset age groups. Can J Public Health. 2020;111:787–93.
Van Ourti T, O’Donnell O, Koç H, et al. Effect of screening mammography on breast cancer mortality: Quasi-experimental evidence from the rollout of the Dutch population based program with 17-year follow-up of a cohort. Int J Cancer. 2020;146:2201–8.
A Gilman: The initial clinical trial of nitrogen mustard Am J Surg 105: 574– 578,1963
H Gurney: How to calculate the dose of chemotherapy Br J Cancer 86: 1297– 1302,2002
MJ Moore, C Erlichman: Therapeutic drug monitoring in oncology: Problems and potential in antineoplastic therapy Clin Pharmacokinet 13: 205– 227,1987
M Wenk, S Vozeh, F Follath: Serum level monitoring of antibacterial drugs: A review Clin Pharmacokinet 9: 475– 492,1984
MJ Rybak, BM Lomaestro, JC Rotschafer, etal : Therapeutic monitoring of vancomycin in adults: Summary of consensus recommendations from the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, and the Society of Infectious Diseases Pharmacists Pharmacotherapy 29: 1275– 1279,2009
BD Kahan, P Keown, GA Levy, etal: Therapeutic drug monitoring of immunosuppressant drugs in clinical practice Clin Ther 24: 330– 350,2002 discussion 329
C Monchaud, P Marquet: Pharmacokinetic optimization of immunosuppressive therapy in thoracic transplantation: Part I Clin Pharmacokinet 48: 419– 462,2009
VH Mabasa, MH Ensom: The role of therapeutic monitoring of everolimus in solid organ transplantation Ther Drug Monit 27: 666– 676,2005
PN Patsalos, DJ Berry, BF Bourgeois, etal : Antiepileptic drugs: Best practice guidelines for therapeutic drug monitoring—A position paper by the subcommission on therapeutic drug monitoring, ILAE Commission on Therapeutic Strategies Epilepsia 49: 1239– 1276,2008
SL von Winckelmann, I Spriet, L Willems: Therapeutic drug monitoring of phenytoin in critically ill patients Pharmacotherapy 28: 1391– 1400,2008
E Pretorius, H Klinker, B Rosenkranz: The role of therapeutic drug monitoring in the management of patients with human immunodeficiency virus infection Ther Drug Monit 33: 265– 274,2011
WE Evans, MV Relling, JH Rodman, etal : Conventional compared with individualized chemotherapy for childhood acute lymphoblastic leukemia N Engl J Med 338: 499– 505,1998
N Graf, K Winkler, M Betlemovic, etal : Methotrexate pharmacokinetics and prognosis in osteosarcoma J Clin Oncol 12: 1443– 1451,1994
E Gamelin, R Delva, J Jacob, etal : Individual fluorouracil dose adjustment based on pharmacokinetic follow-up compared with conventional dosage: Results of a multicenter randomized trial of patients with metastatic colorectal cancer J Clin Oncol 26: 2099– 2105,2008
