School of Medicine Southside, The University of Queensland, Australia. Mohamed.
Ther Drug Monit. 2012 Jun;34(3):257-65. doi: 10.1097/FTD.0b013e3182557342.
Therapeutic drug monitoring (TDM) and more recently target concentration intervention (TCI) have been widely used in clinical practice for the optimization of drug treatment. TDM and TCI have been applied most frequently in the cardiovascular, respiratory, neurology, and infectious disease areas because the medications used here have both narrow therapeutic indices and a clear relationship between concentration and effect. However, apart from drugs such as methotrexate and 5-fluorouracil, the clinical application of TDM/TCI in oncology is minimal. An important reason for this is that a therapeutic index for most anticancer agents has not been established. However, in the last 20 years, relationships between plasma drug concentrations and clinical outcome have been defined for various chemotherapeutic agents. Defining concentration-effect relationships is also complicated by the fact that cancer is almost always treated with multiple drugs given in combination making the precise definition of the pharmacodynamics of individual agents difficult. The increase in patients with obesity and also those underweight adds to the complexity of effective oncology treatment. This review describes some of the evidence that supports the use of TDM/TCI in oncology. It is proposed that as more patients previously ineligible for chemotherapy become eligible, TDM/TCI may play a critical role in optimizing chemotherapy outcomes. However, pharmacokinetic-pharmacodynamic research to investigate both therapeutic benefit and feasibility in daily clinical practice is required.
治疗药物监测（TDM）和最近的目标浓度干预（TCI）已在临床实践中广泛用于优化药物治疗。TDM 和 TCI 最常用于心血管、呼吸、神经和传染病领域，因为这些领域使用的药物治疗指数较窄，且浓度与疗效之间存在明确的关系。然而，除了甲氨蝶呤和 5-氟尿嘧啶等药物外，TDM/TCI 在肿瘤学中的临床应用非常有限。造成这种情况的一个重要原因是大多数抗癌药物的治疗指数尚未确定。然而，在过去的 20 年中，已经为各种化疗药物定义了血浆药物浓度与临床结果之间的关系。定义浓度-效应关系也很复杂，因为癌症几乎总是使用联合用药的多种药物进行治疗，这使得单个药物的药效学的精确定义变得困难。肥胖患者和体重不足的患者的增加也增加了有效肿瘤治疗的复杂性。本文综述了一些支持 TDM/TCI 在肿瘤学中应用的证据。有人提出，随着越来越多以前不符合化疗条件的患者变得符合条件，TDM/TCI 可能在优化化疗结果方面发挥关键作用。然而，需要进行药代动力学-药效学研究，以调查在日常临床实践中的治疗益处和可行性。
