Pharmacokinetic and pharmacogenetic determinants and considerations in chemotherapy selection and dosing in infants

Janine R. Hutson, Sheila Weitzman, Tal Schechter, Robert J. Arceci, Richard B. Kim, Yaron Finkelstein

Research output: Contribution to journalReview article

Abstract

Introduction: There is a lack of high-quality data regarding optimal chemotherapy dosage regimens among infants. Dosing regimens for chemotherapy during the first year of life are commonly based on empiric recommendations extrapolated from older children; however, balancing efficacy and toxicity is critical as severe adverse drug reactions may lead to treatment failure or reduced adherence to needed medications. Areas covered: This review describes pharmacokinetic and pharmacogenetic considerations when administering chemotherapeutic agents to infants. Examples of commonly used agents are provided with practical recommendations for dosing adjustments. Expert opinion: Optimal chemotherapy for children and infants in particular has lagged behind the remarkable progress in cancer treatment and it is clear that far more basic and clinical research are needed with respect to the mechanistic basis of age-dependent differences in pharmacokinetic parameters. More recent studies which have combined pharmacokinetic data with clinical toxicity and outcome data have resulted in a number of more evidence-based guidelines at least for the initial chemotherapy dosing; however, at present, the dosing of chemotherapy drugs in neonates and infants remains largely empiric.

Original languageEnglish (US)
Pages (from-to)709-722
Number of pages14
JournalExpert Opinion on Drug Metabolism and Toxicology
Volume8
Issue number6
DOIs
StatePublished - Jun 1 2012

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Keywords

  • Chemotherapy
  • Infants
  • Pharmacogenomics
  • Pharmacokinetics

ASJC Scopus subject areas

  • Toxicology
  • Pharmacology

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