A new study, published today in JCO Oncology Practice, finds that oncologists have different perspectives on how to select starting doses for patients with metastatic cancer. The study shares findings from a 2021 international survey of 367 medical oncologists who treat patients with metastatic breast or gastrointestinal (GI) cancers.

Of the oncologists who reported dose reduction at initiation (52%), a majority (89%) also indicated that they “usually” or “sometimes” discussed the potential trade-offs between efficacy and toxicity from different doses with their patients. The authors found that GI specialists were more likely to report dose reduction at initiation of treatment than generalist or breast specialists.

“The findings demonstrate that more data and improved approaches to drug development are needed to help oncologists and patients select the optimal dose in order to enhance patient quality of life,” said Rachel B. Jimenez, MD, lead author of the study, Assistant Professor of Radiation Oncology at Harvard Medical School and the Chair for Quality and Safety in the Department of Radiation Oncology at Massachusetts General Hospital.

Other key findings include:

• 89% of oncologists supported future clinical trials that seek to determine the minimal effective treatment dose versus the maximum tolerated dose.
• More than two-thirds of respondents—72%—agree that the initial dose should align with the patient’s preferences for balancing efficacy and side effects. However, only about a third—35.5%—reported usually reviewing dose selection with patients.
• A majority —65%—agreed that it is acceptable to lower starting doses to reduce side effects even at the potential expense of efficacy.
• Nearly half—45%—reported that they believe oncologists should start at a lower dose and consider increasing the dose for future treatment cycles if the drug is well-tolerated.
• More than half of respondents—53%—believed that oncologists should start with the recommended dose and lower it based on any side effects. These perceptions varied depending on the type of provider.

Authors emphasize that the data shed light on the emerging issue of dose selection in oncology, add to the dialogue about this critical topic, and highlight the possible need for optimized or standardized dose selection strategies. As the discussion continues to evolve, they note clinical trials and other types of medical trials may guide oncologists and other members of the oncology care teams to follow recommended dosing that is tailored for various populations.

This manuscript is the latest ASCO initiatives on optimizing dosing strategies. In May 2022, ASCO and the U.S. Food and Drug Administration (FDA) co-led a virtual workshop on optimizing dosing strategies.

Read the full article in JCO Oncology Practice.

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