Exploring an approach to reduced-frequency dosing
The decision? A unique Fred Hutch-developed approach that called for a lower-intensity treatment every three months instead of every four weeks. Lisa Tachiki, MD, and Shailender Bhatia, MD, recently published a study about the approach and are engaged in ongoing research to show that reduced-frequency dosing, an approach to “step-down dosing,” may be a good option.
Reduced-frequency dosing has been used with a number of skin cancer patients at Fred Hutch, but the same principles apply to kidney cancer patients.
“This approach is unique to our center,” Hall said. “In some cancers, there is a growing concern there could be late progression years later, so the thinking is that continued treatment may reduce that chance.”
Spacing out dosing is not a standard way to deliver immunotherapy, but it may become more accepted for those patients who have had good responses to standard dosing.
“We have data to show that if we increase the time between doses after patients like Lacey have responded well to standard doses of immunotherapy, patients may continue to do well without compromising the efficacy of immunotherapy,” Tachiki said. “There is biological evidence that step-down dosing would be relevant for any cancer that responds to immunotherapy.”
One compelling reason to opt for step-down dosing is that patients can be extremely reluctant to stop a drug that’s working well to keep them alive. Some research has found that stopping immunotherapy after a year instead of two years is not as effective at controlling lung cancer.
“Reduced-frequency dosing provides an option for patients to continue immunotherapy, rather than stop entirely, while still using less drug and saving cost and time of drug infusions,” said Tachiki. “It's a middle-path approach.”
The ideal duration for reduced-frequency dosing is unknown, but patients such as Lacey are helping physician-scientists crack the code by participating in research.
“My life has changed,” said Lacey, who runs Museum Without Walls, a nonprofit she started two decades ago that develops oral history programs around themes of racism and intolerance. "I was really depressed. I was grieving. I missed my dad. But the moment I got this diagnosis, I had a clear epiphany that no, I didn’t want to die. I see life differently, and my appreciation for every moment, even when I'm exhausted, is different, and I owe that to my best friends and Fred Hutch.”
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