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In phase I clinical trials, gefitinib was found to be well tolerated, with clinical efficacy observed well below the maximum tolerated dose.
It is suggested that when determining a phase II dose during a phase I gene therapy study, the aim should be to identify the dose that can achieve the maximum biologic effect, which can occasionally reach a plateau at doses below the maximum tolerated dose.
It is also noteworthy that therapeutic gains in both experimental tumors were achieved with doses of radioactivity that are well below the maximum tolerated dose of approximately 800 µCi for 188Re-labeled IgG1s in mice [26], and as such the doses used were not expected to produce any short- or long-term toxicities.
The recommended dose for the Phase II study was the dose level immediately below the maximum tolerated dose.
Nevertheless, at exposures well below the maximum tolerated dose, diazinon reduced the membrane protein:total protein ratio, a result in keeping with restriction of neuritic outgrowth.
Notably only the IC50 concentration in the MGMT negative cell lines (MED1) was below the maximum tolerated dose of TMZ used in clinical trial [ 79].
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This is driven by the concept of the optimal biological dose (OBD) that, for such targeted therapies, may be well below and more relevant than the maximum tolerated dose.
When at least two out of six patients at the same dose level developed a significant toxicity, this was considered to be a dose-limiting toxicity (DLT) and the dose was the maximum administered dose; the level below this was therefore considered the maximum tolerated dose (MTD).
The maximum tolerated dose level was established as the tolerated dose level below which excessive DLTs (at a rate ≥33%%) had been reached.
The maximum tolerated Ba deficiency is slightly below 10%.
The maximum tolerated dose (MTD) was defined as the last dose tested below the non-tolerated dose.
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