Loading doses for costly cancer biologicals: Sound pharmacology or unnecessary extravagance?

The rising cost of new molecularly-targeted anticancer drugs has become a major issue in oncology. One small but significant factor contributing to this problem is the routine co-administration of loading doses, which may inflate the cost of the first treatment by as much as US$1000. Here, we question the cost-effectiveness of this practice in cancer patients on several grounds, including non-urgent pace of disease, lack of evidence for survival benefit, weak dose-dependency of biopharmaceutical efficacy in cancer and the unproven validity of the ‘volume of distribution’ concept applied to target-specific drugs.