Change of dosing paradigm in oncology

Drug dosing based on the body surface area (BSA) has been the mainstay of oncological treatment over the last decades. Although this seems to be an adequate measure of an individual’s appropriate dose for traditional chemotherapeutic drugs according to their somatometric data, it is currently being questioned due to the delivery of novel treatments such as monoclonal antibodies. Most modern regimes require either a flat (fixed)-dosing model, independent of body weight, or a weight-based administration pattern, mainly depending on specific pharmacokinetic data. However, even in this case, some controversy exists about whether this model is sufficient. Given the recent findings from pharmacokinetic studies, perhaps we should reconsider the solid hypothesis that drug efficacy correlates with dose, as many molecules seem to be efficient even in the lowest doses administered, with minimum toxicity.