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Pharmacology Projects

Therapeutic drug monitoring for the treatment of childhood cancer patients.

Therapeutic Drug Monitoring Approaches to Patient Treatment

We have worked in therapeutic drug monitoring (TDM) for several years.

The utility of therapeutic drug monitoring (TDM) relates to the measurement of drug levels in biological samples. This can then be used to individualise patient treatment through drug dose changes. The aim is to to improve drug efficacy and/or reducing toxicity.

We have identified childhood cancer patient subpopulations who benefit from TDM treatment approaches with specific, commonly-used chemotherapeutics. These patients include:

  • pre-term infants and neonates
  • anephric patients
  • patients receiving high dose chemotherapy
Therapeutic drug monitoring

Associated publications

Barnett S, Makin G, Tweddle DA, Osborne C, Veal GJ. Generation of evidence-based carboplatin dosing guidelines for neonates and infantsBritish Journal of Cancer 2023, 129, 1773–1779.

Barnett S, Nyein AC, Galler M, Jamieson D, Davies M, Connor P, Veal GJ. Excessive vincristine exposure in a child being treated for acute lymphoblastic leukaemia with underlying Dubin–Johnson syndrome: a case reportCancer Chemotherapy and Pharmacology 2023, 92, 325–328.

Barnett S, Hellman F, Parke E, Makin G, Tweddle DA, Osborne C, Hempel G, Veal GJ. Vincristine dosing, drug exposure and therapeutic drug monitoring in neonate and infant cancer patientsEuropean Journal of Cancer 2022, 164, 127-136.

Nijstad AL, Barnett S, Lalmohamed A, Bérénos IM, Parke E, Carruthers V, Tweddle DA, Kong J, Zwaan CM, Huitema ADR, Veal GJ. Clinical pharmacology of cytotoxic drugs in neonates and infants: providing evidence-based dosing guidanceEuropean Journal of Cancer 2022, 164, 137-154.

Carruthers V, Barnett S, Rees R, Arif T, Slater O, Ramanujachar R, Johnson K, Graham C, Burke GAA, Veal GJ. Clinical utility of vinblastine therapeutic drug monitoring for the treatment of infantile myofibroma patients – a case seriesPediatric Blood & Cancer 2022, e29722.

Barnett S, Holden V, Campbell-Hewson Q, Veal GJ. Perspectives and expertise in establishing a therapeutic drug monitoring programme for challenging childhood cancer patient populationsFrontiers in Oncology 2022, 11, 815040.

Barnett S, Kong J, Makin G, Veal GJ. Over a decade of experience with carboplatin therapeutic drug monitoring in a childhood cancer setting in the United KingdomBr J Clin Pharmacol 2021 87: 256-262

Hawley J, Veal GJ, Errington J, McDonald LG, Tweddle DA. The use of pharmacokinetically guided carboplatin chemotherapy in a pre-term infant with neuroblastoma associated spinal cord compressionPed Blood Cancer 2019 e27825 1-3

Thomas F, Veal GJ, El Balkhi S, Lafont T, Picard N, Brugieres L, Chatelut E, Piguet C. Therapeutic drug monitoring and dose adaptation of cisplatin in a newborn with hepatoblastoma: a case reportCancer Chemother Pharmacol 2018 82: 361-365

Veal GJ, Errington J, Sastry J, Chisholm J, Brock P, Morgenstern D, Pritchard-Jones K, Chowdhury T. Adaptive dosing of anticancer drugs in neonates – facilitating evidence-based dosing regimensCancer Chemother Pharmacol 2016 77: 685-692

Veal GJ, Errington J, Hayden J, Hobin D, Murphy D, Dommett RM, Tweddle DA, Jenkinson H, Picton S. Carboplatin therapeutic monitoring in preterm and full-term neonatesEur J Cancer 2015 51: 2022-2030

Bardin C, Veal G, Paci A, Chatelut E, Astier A, Leveque D, Widmer N, Beijnen J. Therapeutic drug monitoring in cancer – Are we missing a trick? Eur J Cancer 2014 50: 2005-2009

Veal GJ, Errington J, Rowbotham SE, Illingworth NA, Malik G, Cole M, Daly AK, Pearson ADJ, Boddy AV. Adaptive dosing approaches to the individualization of 13-cis-retinoic acid (isotretinoin) treatment for children with high-risk neuroblastomaClin Cancer Res 2013 19: 469-479