The Current Status and Future Prospects of Therapeutic Drug Monitoring of Chemotherapy in Jordan

In the last 20 years, several prospective studies have been conducted to improve the expediencyof Therapeutic Drug Monitoring(TDM) application in the field of oncology. However, to start and maintain modern TDM services in developing countries requires more funding and education to reform clinical practices.In the present study, we aimed to determine the current practice of chemotherapy and non-chemotherapy TDM in Jordan.A self-administered questionnaire was developed based on reviews of current state-of-art technology and knowledge with respect to TDM of chemotherapeutic and non-chemotherapeutic agents that are frequently used in oncology. The survey was conducted between December 2009 and February 2010 in two main cancer centers in Jordan. Initial dose individualization based on BSA (96.8%) was indicated as the most common approach. Only 17.5% (n=7) and 67.7% (n=27) of the participants indicated that TDM services are routinely provided forchemotherapeutic or non-chemotherapeutic drugs in cancer patients at their institutions, respectively. The most frequent chemotherapy TDM requests were for methotrexate (n=5) and 5-fluorouracil (n=3), whereas most non-chemotherapy drug level determinations were for tacrolimus (n=22) and cyclosporine (n=22). The majority (83.9%) of respondents acknowledged the unavailability of specialized software for dose adjustment based on computer modeling of observed serum levels.Herein, the evidence presented in this study of low rates for drug concentration monitoring in cancer patients should prompt additional awareness programs of TDM clinical and appropriate economic outcomes, particularly for certain therapeutic regimens of proven value.