title: Chemotherapy dosing in overweight and obese patients with cancer.
abstract: Retrospective and prospective preclinical and clinical data have demonstrated an association between chemotherapy dose intensity and both clinical efficacy and toxicity. The optimum tolerable and effective dose and schedule of chemotherapeutic agents is based on data from dose-finding studies and early clinical trials. There is considerable evidence that reductions in the recommended dose intensity often occurs in actual clinical practice, particularly among overweight and obese patients with cancer. With increasing rates of obesity, and variation and uncertainty about appropriate dosing of chemotherapy in obese patients, ASCO has generated clinical practice guidelines for appropriate chemotherapy dosing for obese adult patients with cancer. Without evidence of any increase in treatment-related toxicity among obese patients receiving chemotherapy, the guidelines recommend that, after considering any accompanying comorbidities, chemotherapy dosing should be calculated based on body surface area using actual weight, rather than an estimate or idealization of weight. While further research is needed, pharmacokinetic studies support the use of actual body weight to calculate chemotherapy doses for most chemotherapy drugs in obese patients. We highlight the issue of chemotherapy dosing in this population, how a more personalized approach can be achieved, as well as discussing areas for further research.
authors.affiliation: Comparative Effectiveness and Outcomes Research, Duke University and the Duke Cancer Institute, 2424 Erwin Road, Suite 205, Durham, NC 27705, USA. gary.lyman@duke.edu
authors.forename: Gary H
authors.initials: GH
authors.lastname: Lyman
authors.forename: Alex
authors.initials: A
authors.lastname: Sparreboom
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage* / Q000493:pharmacokinetics; D001830:Body Surface Area; D001835:Body Weight; D054796:Drug Dosage Calculations; D006801:Humans; D009369:Neoplasms / Q000188:drug therapy* / Q000473:pathology; D009765:Obesity / Q000150:complications*; D050177:Overweight / Q000150:complications*; D010818:Practice Patterns, Physicians'; D014018:Tissue Distribution