TDM TDM Timing of Specimen Collections Single most

TDM

TDM * Timing of Specimen Collections • Single most important factor in TDM • Steady state must be reached before TDM begins. • Usually draw at peak or trough • Peak for drugs given IV or if Pt has signs of toxicity shortly after dose • Majority drawn as trough • 처음 투약 시 or 투약방법이나 용량 변경시 • F/U TDM : 일정 시간에 채혈

Tumor markers * Classification of tumor markers 1) Oncofetal Ag : AFP, CEA, SCC, TPA 2) Carbohydrate Ag Mucin markers : CA 125, CA 15 -3, CA 549, CA 27. 29, Du-PAN-2 Bl group Ag related markers : CA 19 -9, CA 15 -5, CA 50, CA 72 -4, CA 242 3) Enzyme : ALP, CK, LD (LD 5) NSE (NB, pheochromocytoma, SCLC) PAP, PSA 4) Hormones : ACTH, calcitonin, h. CG 5) Proteins : β 2 m, C-peptide, ferritin, Ig… 6) Genetic markers

Tumor markers * Tumor marker의 유용성 평가 1) Reference range : 건강인 120명, mean ± 2 SD or 백분위법 Decision level : 예측치 모델 2) 예측치 모델 – decision level - sensitivity, specificity, predictive value - ROC curve : AUC - Which marker or which level ? Sensitivity 검사 양 성 질병 유 질병 무 a b c 검사 음 성 Sensitivity = d a/a+c Specificity = d/b+d 1 -Specificity

* Rec. for tumor marker Tumor markers 1) Never rely on single test result : serial test 2) same lab, same assay kit 3) Select highest marker before op. : 재발 감시 4) Consideration of half-life PSA 3일, h. CG 12 -20 h, AFP 5일 5) Multiple tumor markers : simultaneous test of CEA, CA 19 -9, CA 15 -3, CA 125 6) Use of non-specific marker : monitoring of Tx efficacy & recurrence : LD, CEA, TPA… 7) 대사, 배설 장기 고려