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With the weekly schedule, there was relatively little myelosuppression, but peripheral neuropathy prevented dose escalation above 100 mg m−2.
In those who did not have a dose escalation above the 75 mg/kg/day, 30/96 (31.1%) had a favorable response.
Peripheral neuropathy prohibited dose escalation above 100 mg m−2, and grade 3 neuropathy was observed in two of 21 patients at ⩽100 mg m−2.
One may expect that pemetrexed administration with supplementation would be more tolerable for patients and permit significant dose escalation above the current RD of 500 mg m−2.
Among the initial cohort of 10 patients treated at the first dose level of VPA, three did not undergo dose escalation above 10 mg kg−1 day−1, one for non-compliance and two because of disease progression.
Dose escalation above 5 mg kg−1 per day did not reduce FDG uptake any further (FDG uptake T/C: 49% for 5 mg kg−1 per day and 52% for 15 mg kg−1 per day).
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Whether the increased rate we observed for the 100 mg dose is related to the drug dose itself or to the theoretically higher cumulative disease activity of patients receiving this dose due to dose escalation (see above and as discussed elsewhere [ 2]) remains unknown.
Although the experts advocated de-escalation in above-mentioned situations, high-quality evidences are needed in this field.
Also listed in Table 3 are the numbers of patients at each dose level who experienced toxicity greater than grade 1 at the time when the decision to increase the dose of the next cohort of patients was made (see dose-escalation schedule, above).
The remaining ongoing dose escalation trials (see above) give doses of 68 73 Gy in the control groups and 78 82 Gy in the escalated dose groups.
Therefore, dose escalation of erlotinib above the approved dose of 150 mg is not recommended for use in this disease setting.
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CEO of Professional Science Editing for Scientists @ prosciediting.com