Drug therapies uncertainties

Pharmacogenetics provides a rational framework to minimize the uncertainty in outcome of drug therapy and clinical trials and thereby should significantly reduce the risk of drug toxicity. The reader is referred to the Internet sources in Table 20.1 for more details on pharmacogenetics and drug development. Potential improvements in patient inclusion criteria will be addressed later in this chapter. 

One of the main messages of the 2001 American Association of Cancer Research meeting was this variability in response to drugs can lead to therapeutic failure or adverse drug reactions in individuals or subpopulations of patients [12]. It is now recognized that all patients do not react in the same way to chemotherapy, but in some cases treatment response can be predicted. Pharmacogenetics provides the opportunity to tailor drug treatments and decrease uncertainties of therapy. 

In 1974, the Sugarloaf Conference [3] underscored the empiric nature of many applications of inhalation therapy, as it was called at that time. The scientific basis for many treatments was very weak. Although there has been considerable progress since the early 1980s, there are today still many uncertainties about inhaled drug delivery and many variations of delivery equipment and methods. A more recent consensus statement reviews some advances and describes continuing needs for investigation [4]. 

Despite these uncertainties, there seems to be a general tendency in the reported studies to support the hypothesis that low doses of aspirin may be more effective in anti-thrombotic therapy than the conventional doses. As mentioned, the results of these studies vary somewhat in terms of definite recommendations of the lowest, clinically useful dose of the drug for prevention of thrombosis, possibly due to the factors discussed above. Perhaps an even better solution would be to use long intervals between doses preferably the drug should not be given more often than... 

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