Study Sheds Light on Need for Optimal Dosing Standards for Patients With Metastatic Cancer

Beliefs and Practices Around Drug Dose Selection and Factors Influencing Decision-Making Vary Among Oncologists

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A new study, published recently in JCO Oncology Practice, found that oncologists have different perspectives on how to select starting doses for patients with metastatic cancer.1 The study shared findings from a 2021 international survey of 367 medical oncologists who treat patients with metastatic breast or gastrointestinal cancer.

Of the oncologists who reported dose reduction at initiation (52%), a majority (89%) also indicated they “usually” or “sometimes” discussed the potential trade-offs between efficacy and toxicity from different doses with their patients. The authors found that gastrointestinal specialists tended to be more likely to report dose reduction at initiation of treatment than generalists or breast specialists.

“The findings demonstrate that more data and improved approaches to drug development are needed to help oncologists and patients select the optimal dose in order to enhance patient quality of life,” said lead author of the study Rachel B. Jimenez, MD, Assistant Professor of Radiation Oncology at Harvard Medical School and Chair for Quality and Safety in the Department of Radiation Oncology at Massachusetts General Hospital.

Other key findings include the following:

  • A total of 89% of oncologists supported future clinical trials that seek to determine the minimal effective treatment dose vs the maximum tolerated dose.
  • More than two-thirds of respondents—72%—agreed that the initial dose should align with the patient’s preferences for balancing efficacy and side effects. However, only about one-third—35.5%—reported usually reviewing dose selection with patients.
  • A majority—65%—agreed that it is acceptable to lower starting doses to reduce side effects, even at the potential expense of efficacy.
  • Nearly half—45%—reported that they believe oncologists should start at a lower dose and consider increasing the dose for future treatment cycles if the drug is well tolerated.
  • More than half of respondents—53%—believed that oncologists should start with the recommended dose and lower it based on any side effects. These perceptions varied depending on the type of provider.

The authors emphasized that the data shed light on the emerging issue of dose selection in oncology, add to the dialogue about this critical topic, and highlight the possible need for optimized or standardized dose-selection strategies. As the discussion continues to evolve, they noted clinical trials and other types of medical trials may guide oncologists and other members of the oncology care teams to follow recommended dosing that is tailored for various populations.

This manuscript is the latest ASCO initiative on optimizing dosing strategies. In May 2022, ASCO and the U.S. Food and Drug Administration co-led a virtual workshop on optimizing dosing strategies.2 


1. Jimenez RB, Schenkel C, Levit LA, et al: Oncologists’ perspectives on individualizing dose selection for patients with metastatic cancer. JCO Oncol Pract. September 20, 2022 (early release online).

2. Getting the dose right: Optimizing dose selection strategies in oncology—An FDA-ASCO virtual workshop. Available at Accessed September 21, 2022.

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