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. Author manuscript; available in PMC: 2017 Jul 1.
Published in final edited form as: Clin Cancer Res. 2016 Mar 24;22(13):3121–3123. doi: 10.1158/1078-0432.CCR-16-0370

Figure 1. Illustration of 9 patients matriculating through an integrated personalized treatment strategy.

Figure 1

Baseline information including CYP2D6 phenotype (poor (PM), intermediate (IM), or extensive (EM) metabolizer) and clinical information (body mass index, drug-drug interactions, etc.) are used to predict endoxifen concentration during treatment with the typical dose of 20 mg/day. Patients predicted to be above the efficacy threshold (hatched green horizontal line) are started at the typical dose. Patients predicted to be below the threshold are pre-emptively dose escalated by 10 or 20 mg/day. After 1 month of treatment, endoxifen concentration is measured to determine whether further dose personalization is necessary. Some patients who were not expected to require escalation (i.e. #2) have sub-therapeutic concentration and require a dose increase. Other patients who had a dose escalation (i.e. #8) require further escalation to reach therapeutic endoxifen levels. Ultimately, all patients achieve therapeutic endoxifen concentrations, maximizing tamoxifen treatment effectiveness.