Appropriate Systemic Therapy Dosing for Obese Adult Patients With Cancer: ASCO Guideline Update

Abstract

PURPOSE To provide recommendations for appropriate dosing of systemic antineoplastic agents in obese adults with cancer. METHODS A systematic review of the literature collected evidence regarding dosing of chemotherapy, immunotherapy, and targeted therapies in obese adults with cancer. PubMed and the Cochrane Library were searched for randomized controlled trials, meta-analyses, or cohort studies published from November 1, 2010, through March 27, 2020. ASCO convened an Expert Panel to review the evidence and formulate recommendations. RESULTS Sixty studies, primarily retrospective, were included in the review. Overall, the evidence supported previous findings that obese adult patients tolerate full, body-size–based dosing of chemotherapy as well as nonobese patients. Fewer studies have addressed the dosing of targeted therapies and immunotherapies in relation to safety and efficacy in obese patients. RECOMMENDATIONS The Panel continues to recommend that full, weight-based cytotoxic chemotherapy doses be used to treat obese adults with cancer. New to this version of the guideline, the Panel also recommends that full, approved doses of immunotherapy and targeted therapies be offered to obese adults with cancer. In the event of toxicity, the consensus of the Panel is that dose modifications of systemic antineoplastic therapies should be handled similarly for obese and nonobese patients. Important areas for future research include the impact of sarcopenia and other measures of body composition on optimal antineoplastic dosing, and more customized dosing based on pharmacokinetic or pharmacogenetic factors. Additional information is available at www.asco.org/supportive-care-guidelines .

Risk Factors Predicting Chemotherapy-induced Severe Neutropenia and Outcome in Advanced Stage Non-small Cell Lung Cancer: Data from the Limited Resource in Thailand

“…Therefore, it was unnecessary to use uncapped chemotherapy doses by body size in patients with solid tumors [33][34][35]. Recently, the ASCO guideline provided evidence that myelosuppression is the same in obese and non-obese patients [36]. However, the ASCO guidelines based its research on mostly Caucasian and African-American cancer patients pool.…”

Review article: obesity and colorectal cancer

“…In this setting, dose reduction or dose capping (at body surface area of 2 m 2 ) is common practice because physicians fear toxicity which may result from high doses 98 . However, 99 the recently updated guidelines of the American Society of Clinical Oncology continue to recommend full dosage chemotherapy for patients with obesity, 100 and a meta‐analysis demonstrated no significant difference in full‐dose chemotherapy‐related toxic effect on patients with obesity 101 . These patients with metastatic CRC do not experience more toxicity or more frequent dose reduction because of toxicity.…”

Sex and Gender Differences in Anticancer Treatment Toxicity: A Call for Revisiting Drug Dosing in Oncology

“…However, obese patients can be sarcopenic and at risk of excess toxicity. Until the impact of sarcopenia and other measures of body composition on optimal antineoplastic dosing has been addressed, clinical guidelines recommend using the full, approved doses of anticancer treatments for obese adults with cancer ( 58 , 59 ).…”