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.
Increasing obesity rates represent a global public health problem that increases the risk of many diseases and conditions, including cancer
Chemotherapy dosing in adult cancer patients is generally based on body surface area; data suggest that obese patients receiving full chemotherapy doses do not experience greater toxicity than healthy weight individuals
Overweight and obese patients with cancer are often undertreated because arbitrary limits are used to calculate the dose of systemic chemotherapeutic agents
Retrospective and prospective clinical trial data suggest that reductions in delivered chemotherapy dose intensity is associated with increased rates of disease recurrence and cancer-associated mortality
Clinical practice guidelines have been developed for appropriate dosing of chemotherapy in adult patients that should enhance the quality of patient care and improve clinical outcomes
Further research on the application of pharmacokinetic and pharmacogenetic principles to chemotherapy dosing may enable more personalized treatment of obese patients with cancer
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G. H. Lyman is co-chair and A. Sparreboom is a member of the ASCO Expert Panel involved in formulating the guidelines on appropriate chemotherapy dosing for obese adult patients with cancer.
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Lyman, G., Sparreboom, A. Chemotherapy dosing in overweight and obese patients with cancer. Nat Rev Clin Oncol 10, 451–459 (2013). https://doi.org/10.1038/nrclinonc.2013.108
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