Abstract
The American Society of Clinical Oncology recently published a Clinical Practice Guideline entitled “Appropriate Chemotherapy Dosing for Obesity Adult Patients with Cancer.” The panel recommended that full weight (actual weight)-based cytotoxic chemotherapy doses are used to treat obese patients with cancer, particularly when the goal of treatment is cure. However, no study has examined dosage calculation methods used for obese cancer patients in Japan. Here, we retrospectively studied the relationships between chemotherapy dose intensity, the occurrence of adverse events, and treatment outcomes in obese patients undergoing chemotherapy. Patients were divided into two groups: the actual BW group (BWg) was composed of patients receiving dosage amounts calculated using their actual BW (n = 64), and the ideal BWg was composed of patients receiving dosage amounts calculated using their ideal BW (n = 41). There were significant differences in the incidence of Grade 3/4 hematological toxicity in the actual and ideal BWg in solid tumor patients, but not in patients with hematological malignancies. In solid tumor patients with ≥30 body mass index (BMI), the incidence of Grade 3/4 hematological toxicity was significantly lower in the ideal BWg than in the actual BWg. Particularly, in patients with complications, incidence of Grade 4 hematological toxicity was significantly higher in the actual BWg than in the ideal BWg. These results suggest that the tumor type, degree of obesity, complications, and choice of chemotherapy regimen should be considered when determining chemotherapy dosage for obese patients.
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Abbreviations
- BSA:
-
Body surface area
- BW:
-
Body weight
- BMI:
-
Body mass index
- BWg:
-
Body weight group
- CTCAE:
-
Common Terminology Criteria for Adverse Events
- eGFR:
-
Estimated glomerular filtration rate
- SPSS:
-
Statistical Package for Social Science
References
Kelly T, Yang W, Chen CS, Reynolds K, He J (2008) Global burden of obesity in 2005 and projections to 2030. Int J Obes (Lond) 32:1431–1437
Tang H, Dong X, Hassan M, Abbruzzese JL, Li D (2011) Body mass index and obesity- and diabetes-associated genotypes and risk for pancreatic cancer. Cancer Epidemiol Biomarkers Prev 20:779–792
Ehdaie B, Chromecki TF, Lee RK, Lotan Y, Margulis V, Karakiewicz PI, Novara G, Raman JD, Ng C, Lowrance WT, Scherr DS, Shariat SF (2011) Obesity adversely impacts disease specific outcomes in patients with upper tract urothelial carcinoma. J Urol 186:66–72
Hanley MJ, Abernethy DR, Greenblatt DJ (2010) Effect of obesity on the pharmacokinetics of drugs in humans. Clin Pharmacokinet 49:71–87
Blouin RA, Warren GW (1999) Pharmacokinetic considerations in obesity. J Pharm Sci 88:1–7
Reiss RA, Haas CE, Karki SD, Gumbiner B, Welle SL, Carson SW (1994) Lithium pharmacokinetics in the obese. Clin Pharmacol Ther 55:392–398
Bauer LA, Black DJ, Lill JS (1998) Vancomycin dosing in morbidly obese patients. Eur J Clin Pharmacol 54:621–625
Rodvold KA, Rushing DA, Tewksbury DA (1988) Doxorubicin clearance in the obese. J Clin Oncol 6:1321–1327
Powis G, Reece P, Ahmann DL, Ingle JN (1987) Effect of body weight on the pharmacokinetics of cyclophosphamide in breast cancer patients. Cancer Chemother Pharmacol 20:219–222
Abdah-Bortnyak R, Tsalic M, Haim N (2003) Actual body weight for determining doses of chemotherapy in obese cancer patients: evaluation of treatment tolerability. Med Oncol 20:363–368
Meyerhardt JA, Tepper JE, Niedzwiecki D, Hollis DR, McCollum AD, Brady D, O’Connell MJ, Mayer RJ, Cummings B, Willett C, Macdonald JS, Benson AB 3rd, Fuchs CS (2004) Impact of body mass index on outcomes and treatment-related toxicity in patients with stage II and III rectal cancer: findings from Intergroup Trial 0114. J Clin Oncol 22:648–657
Hunter RJ, Navo MA, Thaker PH, Bodurka DC, Wolf JK, Smith JA (2009) Dosing chemotherapy in obese patients: actual versus assigned body surface area (BSA). Cancer Treat Rev 35:69–78
Rosner GL, Hargis JB, Hollis DR, Budman DR, Weiss RB, Henderson IC, Schilsky RL (1996) Relationship between toxicity and obesity in women receiving adjuvant chemotherapy for breast cancer: results from cancer and leukemia group B study 8541. J Clin Oncol 14:3000–3008
Colleoni M, Li S, Gelbefr RD, Price KN, Coates AS, Castiglione-Gertsch M, Goldhirsch A (2005) Relation between chemotherapy dose, oestrogen receptor expression, and body-mass index. Lancet 366:1108–1110
American Society of Clinical Oncology (2012) Appropriate chemotherapy dosing for obese adult patients with cancer: american Society of Clinical Oncology clinical practice guideline. J Clin Oncol 13:1553–1561
Japan Society for the Study of Obesity (2002) New criteria for ‘Obesity Disease’ in Japan. Circ J 66:987–992
Du Bois D, Du Bois EF (1916) A formula to estimate the approximate surface area if height and weight be known. Arc Intern Med 17:863–871
Matsuzawa Y, Tokunaga K, Kotani K, Keno Y, Kobayashi T, Tarui S (1990) Simple estimation of ideal body weight from body mass index with the lowest morbidity. Diabetes Res Clin Pract 10:159–164
Calle E, Rodriguez C, Walker-Thurmond K, Thun MJ (2003) Overweight, obesity, and mortality from cancer in a prospectively studied cohort of US adults. N Engl J Med 348:1625–1638
Flegal KM, Carroll MD, Kit BK, Ogden CL (2012) Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999–2010. JAMA 307:491–497
Mayers C, Panzarella T, Tannock IF (2001) Analysis of the prognostic effects of inclusion in a clinical trial and of myelosuppression on survival after adjuvant chemotherapy for breast carcinoma. Cancer 91:2246–2257
Munakata M, Nunokawa T, Yoshinaga K, Toyota T; J-TOPP Study Group (2006) Brachial-ankle pulse wave velocity is an independent risk factor for microalbuminuria in patients with essential hypertension-a Japanese trial on the prognostic implication of pulse wave velocity (J-TOPP). Hypertens Res 29:515–521
Superfin D, Iannucci AA, Davies AM (2007) Commentary: oncologic drugs in patients with organ dysfunction: a summary. Oncologist 12:1070–1083
Sparreboom A, Wolff AC, Mathijssen RH, Chatelut E, Rowinsky EK, Verweij J, Baker SD (2007) Evaluation of alternate size descriptors for dose calculation of anticancer drugs in the obese. J Clin Oncol 25:4707–4713
Butturini AM, Dorey FJ, Lange BJ, Henry DW, Gaynon PS, Fu C, Franklin J, Siegel SE, Seibel NL, Rogers PC, Sather H, Trigg M, Bleyer WA, Carroll WL (2007) Obesity and outcome in pediatric acute lymphoblastic leukemia. J Clin Oncol 25:2063–2069
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Miyahara, T., Mochinaga, S., Kimura, S. et al. Effects of tumor type, degree of obesity, and chemotherapy regimen on chemotherapy dose intensity in obese cancer patients. Cancer Chemother Pharmacol 71, 175–182 (2013). https://doi.org/10.1007/s00280-012-1994-8
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DOI: https://doi.org/10.1007/s00280-012-1994-8