A recent study led by patient advocates underscores the urgent need for innovative dosing strategies to improve the well-being of individuals with metastatic breast cancer. The research, published in JCO Oncology Practice, highlights the prevalence of treatment-related adverse events and the potential benefits of dose optimization.
The study, initiated by the Patient-Centered Dosing Initiative, involved an anonymous online survey of 1,221 patients with self-reported metastatic breast cancer. The survey aimed to determine the prevalence and extent of treatment-related adverse events, patient-physician communication, and perceptions about higher versus lower doses.
High Incidence of Adverse Events
The survey revealed that 86.1% of patients experienced at least one substantial treatment-related adverse event. Of those who experienced adverse events, 97.6% notified their physician, and 81.7% received help from their provider. Notably, 20% of patients had to visit the emergency room due to a side effect of their medication, and 43% had to miss a treatment due to drug toxicity.
Benefits of Dose Reduction
The study also found that 82.6% of the 556 patients who received dose reductions reported feeling better after the reduction. More than half (53.3%) of survey respondents did not believe a higher dose would necessarily be more effective than a lower dose, and 92.3% were willing to discuss flexible dosing options with their physician to improve quality of life.
Implications for Dose Optimization
"The FDA has really grabbed onto this concept," said study co-author Julia Maues, MA, a member of the Patient-Centered Dosing Initiative. "They know patients need better dosing, especially those with metastatic disease."
The findings align with the FDA’s Project Optimus, launched in 2021, which aims to reform dose selection and optimization for cancer drugs. The initiative seeks to study multiple doses in earlier trials and for longer periods to identify the best dose for patients.
Current Dosing Strategies
Julia Maues explained that current dosing is often determined through dose escalation in phase 1 clinical trials, where small groups of patients are given increasing doses of the drug until they can’t tolerate the side effects. The dose level before that is considered the maximum tolerated dose (MTD) and is moved to later phases of trials. However, when patients with metastatic breast cancer take these drugs for extended periods, many of the side effects are cumulative.
Patient Perspectives
The study was inspired by Anne Loeser, who passed away from metastatic breast cancer in October 2023. She recognized how dosing affects the quality of life of people living with metastatic breast cancer and wanted to survey patients about the side effects they were experiencing and the impact these effects were having on quality of life.
The study's findings were presented at the ASCO Annual Meeting in 2021, where it received significant attention and was recognized as one of the "best of ASCO." This recognition further amplified the importance of dose optimization efforts in oncology.
