title: Loading doses for costly cancer biologicals: sound pharmacology or unnecessary extravagance?
abstract: The rising cost of new molecularly-targeted anticancer drugs has become a major issue in oncology. One small but significant factor contributing to this problem is the routine co-administration of loading doses, which may inflate the cost of the first treatment by as much as US$1000. Here, we question the cost-effectiveness of this practice in cancer patients on several grounds, including non-urgent pace of disease, lack of evidence for survival benefit, weak dose-dependency of biopharmaceutical efficacy in cancer and the unproven validity of the 'volume of distribution' concept applied to target-specific drugs.
authors.affiliation: Division of Haematology/Oncology, Room 802, Administrative Block, Department of Medicine, University of Hong Kong, Queen Mary Hospital, Pokfulam Road, Pokfulam, Hong Kong. repstein@hku.hk
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Epstein
authors.forename: Bernard M Y
authors.initials: BM
authors.lastname: Cheung
mesh_terms: D000970:Antineoplastic Agents / Q000191:economics / Q000493:pharmacokinetics / Q000627:therapeutic use*; D001688:Biological Products / Q000191:economics / Q000493:pharmacokinetics / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D016527:Drug Costs; D006801:Humans; D009369:Neoplasms / Q000188:drug therapy* / Q000191:economics
chemical_list: D000970:Antineoplastic Agents; D001688:Biological Products