Opinion
Video
Smart Sequencing and Real-World Dosing in mCRC
Panelists discuss how real-world dose adjustment decisions in metastatic colorectal cancer are primarily driven by individual patient factors rather than package insert recommendations, emphasizing the importance of understanding each patient's goals, values, comorbidities, and tolerance thresholds through collaborative multidisciplinary decision-making, since patients frequently ask "how will this make me feel?" and often prioritize quality of life over strict adherence to standard dosing, with the key insight that dose reductions can maximize efficacy by keeping patients on therapy longer rather than causing treatment discontinuation from intolerable toxicities.
This segment emphasizes the evolution toward patient-centered treatment strategies that integrate adverse event management, biomarker utilization, and multidisciplinary care coordination. The discussion transitions from standard treatment protocols to real-world evidence applications, highlighting how clinical decision-making must adapt to individual patient circumstances beyond what clinical trials and package inserts recommend. This approach recognizes that optimal outcomes require balancing efficacy with tolerability in ways that may differ significantly from prescribed dosing recommendations.
Real-world dose adjustment decisions are primarily driven by patient-specific factors rather than strict adherence to prescribing information guidelines. Clinicians must consider individual patient goals, values, and treatment objectives, as some patients prioritize reaching specific life events while others pursue maximum therapeutic intensity. Patient comorbidities play a crucial role in dosing decisions, as clinicians evaluate whether patients can realistically tolerate standard dosing despite meeting clinical trial eligibility criteria. The patient's personal threshold for acceptable side effects becomes a critical determinant, requiring ongoing dialogue about what adverse events patients find tolerable while maintaining treatment benefit.
Quality of life considerations often supersede package insert recommendations in real-world practice, requiring collaborative decision-making among the entire care team including oncologists, pharmacists, and radiation oncologists. Patients frequently express concerns about how treatments will affect their daily functioning, questioning whether survival benefits justify potential severe tolerability issues. The key insight is that dose reductions can maximize efficacy by keeping patients on therapy longer, whereas rigid adherence to standard dosing may lead to treatment discontinuation due to intolerable grade 3-4 toxicities. This patient-centered approach recognizes that maintaining treatment continuity through appropriate dose modifications often yields better outcomes than pursuing maximum doses that result in treatment interruptions or discontinuation.
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