title: Can body composition be used to optimize the dose of platinum chemotherapy in lung cancer? A feasibility study.
abstract: Current methods of dosing platinum-based chemotherapy are suboptimal. Potentially, taking lean body mass into account may help. To inform the design of a future study, we first examined the feasibility and acceptability of such an approach using dual-energy X-ray absorptiometry (DEXA) and explored aspects suggestive of over- and under-dosing.
  
  
  
  Patients with lung cancer offered platinum-based chemotherapy over 1 year were identified and, if eligible, invited to take part in a prospective feasibility study. Questionnaires examined acceptability of the DEXA scan and of a future study that randomized between traditional dosing and one adjusted according to body composition. Dose-limiting toxicity (DLT) and a lack of neutropenia explored potential over- and under-dosing, respectively.
  
  
  
  Of the 173 patients offered chemotherapy, 123 (71%) were ineligible, mostly because of failing entry criteria (84, 49%). Of the 50 approached, 18 (36%) participated, most receiving carboplatin, with 17 providing data. All found a DEXA scan acceptable; other assessments were fully completed, except nadir and pre-chemotherapy blood counts. Most (94%) were prepared to take part in a future study, although the additional hospital visits for a nadir blood count were unpopular with some. Five (29%) patients experienced six episodes of DLT which resulted in discontinuation (3), dose reduction (2) or change to a less toxic regimen (1). Nine (60%) patients experienced either no (2) or inconsistent (7) neutropenia.
  
  
  
  A randomized trial appears acceptable and feasible in patients receiving carboplatin. Adjustment of our entry criteria and avoiding a hospital visit for a nadir blood count should aid recruitment.
authors.affiliation: Department of Palliative Care, Nottingham University Hospitals NHS Trust, Nottingham, NG5 1PB, UK.
authors.forename: Vincent
authors.initials: V
authors.lastname: Crosby
authors.affiliation: Department of Palliative Care, Nottingham University Hospitals NHS Trust, Nottingham, NG5 1PB, UK.
authors.forename: Catherine
authors.initials: C
authors.lastname: D'Souza
authors.affiliation: Department of Palliative Care, Nottingham University Hospitals NHS Trust, Nottingham, NG5 1PB, UK.
authors.forename: Carina
authors.initials: C
authors.lastname: Bristow
authors.affiliation: Department of Palliative Care, Nottingham University Hospitals NHS Trust, Nottingham, NG5 1PB, UK.
authors.forename: Amy
authors.initials: A
authors.lastname: Proffitt
authors.affiliation: Department of Palliative Care, Nottingham University Hospitals NHS Trust, Nottingham, NG5 1PB, UK.
authors.forename: Asmah
authors.initials: A
authors.lastname: Hussain
authors.affiliation: Department of Clinical Oncology, Nottingham University Hospitals NHS Trust, Nottingham, NG5 1PB, UK.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Potter
authors.affiliation: Department of Clinical Oncology, Nottingham University Hospitals NHS Trust, Nottingham, NG5 1PB, UK.
authors.forename: Ivo
authors.initials: I
authors.lastname: Hennig
authors.affiliation: Department of Radiology, Nottingham University Hospitals NHS Trust, Nottingham, NG5 1PB, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: O'Connor
authors.affiliation: Department of Oncology, Division of Palliative Care Medicine, University of Alberta, Edmonton, AB, T6G 1Z2, Canada.
authors.forename: Vickie
authors.initials: V
authors.lastname: Baracos
authors.affiliation: Department of Clinical Oncology, Nottingham University Hospitals NHS Trust, Nottingham, NG5 1PB, UK. andrew.wilcock@nottingham.ac.uk.
authors.forename: Andrew
authors.initials: A
authors.lastname: Wilcock
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D001823:Body Composition / Q000502:physiology*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010984:Platinum / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*
chemical_list: D010984:Platinum
keywords: Chemotherapy; Lean body mass; Lung cancer; Pharmacology; Toxicity