Marginal analysis applied to the dose-response curve.
To improve on drug dosage decisions, the method of "marginal analysis," traditionally found in the economics literature, is applied to the dose-response curve. Marginal analysis is first defined and explained, next the technique is redefined for the clinical setting of dose determination subject to drug efficacy and side effects, and finally an example using adjuvant adriamycin chemotherapy in osteosarcoma is presented. By not using "marginal analysis," clinicians may not be maximizing overall therapeutic success or patient survival. Implications for future clinical trials are discussed, and a suggestion for estimating dose-response is proposed. The technique described should be readily applicable to many dosing problems, and need not be restricted to chemotherapy dosing decisions.
Silber
J H
JH
Division of Pediatric Oncology, Children's Hospital, Philadelphia, PA 19104.
Kaizer
H
H
D001859:Bone Neoplasms / Q000188:drug therapy*; D004305:Dose-Response Relationship, Drug; D004317:Doxorubicin / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D006333:Heart Failure / Q000139:chemically induced; D006801:Humans; D012516:Osteosarcoma / Q000188:drug therapy*; D013223:Statistics as Topic
D004317:Doxorubicin