title: Appropriate chemotherapy dosing for obese adult patients with cancer: American Society of Clinical Oncology clinical practice guideline.
abstract: OBJECTIVE
  To provide recommendations for appropriate cytotoxic chemotherapy dosing for obese adult patients with cancer.
  
  
  METHODS
  The American Society of Clinical Oncology convened a Panel of experts in medical and gynecologic oncology, clinical pharmacology, pharmacokinetics and pharmacogenetics, and biostatistics and a patient representative. MEDLINE searches identified studies published in English between 1996 and 2010, and a systematic review of the literature was conducted. A majority of studies involved breast, ovarian, colon, and lung cancers. This guideline does not address dosing for novel targeted agents.
  
  
  RESULTS
  Practice pattern studies demonstrate that up to 40% of obese patients receive limited chemotherapy doses that are not based on actual body weight. Concerns about toxicity or overdosing in obese patients with cancer, based on the use of actual body weight, are unfounded.
  
  
  CONCLUSIONS
  The Panel recommends that full weight-based cytotoxic chemotherapy doses be used to treat obese patients with cancer, particularly when the goal of treatment is cure. There is no evidence that short- or long-term toxicity is increased among obese patients receiving full weight-based doses. Most data indicate that myelosuppression is the same or less pronounced among the obese than the non-obese who are administered full weight-based doses. Clinicians should respond to all treatment-related toxicities in obese patients in the same ways they do for non-obese patients. The use of fixed-dose chemotherapy is rarely justified, but the Panel does recommend fixed dosing for a few select agents. The Panel recommends further research into the role of pharmacokinetics and pharmacogenetics to guide appropriate dosing of obese patients with cancer.
authors.affiliation: University of Michigan, Ann Arbor, MI, USA.
authors.forename: Jennifer J
authors.initials: JJ
authors.lastname: Griggs
authors.forename: Pamela B
authors.initials: PB
authors.lastname: Mangu
authors.forename: Holly
authors.initials: H
authors.lastname: Anderson
authors.forename: Edward P
authors.initials: EP
authors.lastname: Balaban
authors.forename: James J
authors.initials: JJ
authors.lastname: Dignam
authors.forename: William M
authors.initials: WM
authors.lastname: Hryniuk
authors.forename: Vicki A
authors.initials: VA
authors.lastname: Morrison
authors.forename: T May
authors.initials: TM
authors.lastname: Pini
authors.forename: Carolyn D
authors.initials: CD
authors.lastname: Runowicz
authors.forename: Gary L
authors.initials: GL
authors.lastname: Rosner
authors.forename: Michelle
authors.initials: M
authors.lastname: Shayne
authors.forename: Alex
authors.initials: A
authors.lastname: Sparreboom
authors.forename: Lara E
authors.initials: LE
authors.lastname: Sucheston
authors.forename: Gary H
authors.initials: GH
authors.lastname: Lyman
mesh_terms: D000328:Adult; D000970:Antineoplastic Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000493:pharmacokinetics; D001830:Body Surface Area; D001835:Body Weight; D054796:Drug Dosage Calculations; D019317:Evidence-Based Medicine; D006801:Humans; D009369:Neoplasms / Q000150:complications / Q000188:drug therapy*; D009765:Obesity / Q000150:complications*; D010597:Pharmacogenetics; D010818:Practice Patterns, Physicians'; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents