Dosing of chemotherapy in obese and cachectic patients: results of a national survey

Anglada-Martínez, Helena; Riu-Viladoms, Gisela; Pazo-Oubiña, Fernando do; Molas-Ferrer, Gloria; Mangues-Bafalluy, Irene; Codina-Jané, Carles; Creus-Baró, Natàlia

doi:10.1007/s11096-014-9942-9

Cited by 5 publications

(4 citation statements)

References 22 publications

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“…Dose‐capping in overweight patients is a widespread phenomenon in all types of cancer, although supporting data are sparse . There may be a significant selection bias, because dose reduction is more often performed in patients with worse clinical performance status or significant comorbidities independently of the BMI.…”

Section: Discussionmentioning

confidence: 99%

A high BMI is a risk factor in younger patients with de novo acute myelogenous leukemia

Crysandt

Kramer

Ehninger

et al. 2015

European J of Haematology

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Overweight and obese patients have an increased risk to develop several malignancies and, additionally, body mass index (BMI) impacts on outcome in several solid tumors. However, little is known for AML. We analyzed a cohort of 3526 patients with AML treated in three prospective multicenter trials within the German Study Alliance Leukemia. In multivariate analyses, we identified BMI as an independent risk factor for both DFS (HR 1.014, P = 0.0217) and OS (HR 1.015, P < 0.0036). Interestingly, overweight and obesity seemed to be a risk factor predominantly in patients with de novo AML younger than 65 yr with intermediate risk and adverse cytogenetics. Overweight with a BMI ≥25 kg/m² best discriminated the worse outcome and led to an absolute reduction in long-term survival of 5-7% in the group of all younger patients (3-yr OS 39.9% vs. 47.3%; 10-yr OS 28.7% vs. 33.8%, P = 0.0002). Additionally, response to induction therapy was significantly reduced in these patients (76.9% vs. 82.8%, P < 0.0001). Thus, in younger patients with de novo AML, overweight and obesity are risk factors for impaired response to induction therapy, DFS and OS. This effect is, in part but not fully, explained by dose reduction such as dose-capping at a body surface area of 2 m².

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Section: Discussionmentioning

confidence: 99%

A high BMI is a risk factor in younger patients with de novo acute myelogenous leukemia

Crysandt

Kramer

Ehninger

et al. 2015

European J of Haematology

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“…7 The HOPA survey 20 shows that the use of AIBW is more common in US hospitals than in Spanish ones (46.5%). Nonetheless, the comparison of the results of this survey with those of the survey performed by Anglada et al, in which only 12% of participating hospitals used AIBW to estimate CrCl in obese patients, 31 shows that its use is increasing in Spain.…”

Section: Discussionmentioning

confidence: 73%

Variability of carboplatin dose calculation methods in Spain

Cuesta-Grueso

José

Cajaraville-Ordoñana

et al. 2018

J Oncol Pharm Pract

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Objective To describe and analyze the variability in carboplatin dosing strategies in Spanish hospitals. Methods We designed a questionnaire consisting of 19 multiple-choice items structured in two sections (hospital characteristics and carboplatin dosing data). The questionnaire was sent by e-mail to all the oncology pharmacists included in the register of the Spanish Oncology Pharmacy Group (GEDEFO), and we analyzed the completed questionnaires. Results Response rate was 33.5% from a total of 185 pharmacy services invited to take part in the survey. All hospitals used the Calvert formula to calculate carboplatin dose with glomerular filtration rate estimated by a formula, most commonly the Cockcroft-Gault equation (80.7%). Carboplatin doses were capped in most hospitals (91.9%): 54.8% capped creatinine clearance at 125 mL/min, 11.3% capped serum creatinine, and 19.3% capped both creatinine clearance and serum creatinine. Serum creatinine cut-off values ranged from 0.36 mg/dL to 1 mg/dL. The most commonly used body weight was actual body weight for underweight, normal weight, and overweight patients. The use of adjusted ideal body weight increased in obese and especially in morbidly obese patients. Conclusion The results from this survey show the variability that exists in carboplatin dose calculation methods among Spanish hospitals and the need to continue investigating to find the optimum dose calculation method and unify criteria to avoid differences between sites that can affect effectiveness and toxicity of carboplatin-containing treatments.

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“…BSA values that have been estimated with the Meeh-type equation should be used with caution in patients with very low or very high BMI values (<5 or >45). It should be noted that decisions on the dosage of drugs that are based on BSA in cachectic or obese patients has been questioned [40] , [41] , [42] , [43] .…”

Section: Discussionmentioning

confidence: 99%

Estimation of body surface area in neonates, infants, and children using body weight alone

Edelbi

Lindemalm

Nydert

et al. 2021

International Journal of Pediatrics and Adolescent Medicine

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Background The aim of this study was to use Body Surface Area (BSA) data calculated with the Mosteller equation to test potential new equations that estimate BSA using Body Weight (BW) alone in children aged 0–18 years. Mosteller’s equation, the golden standard at our hospital, was used to calculate the BSA in infants and children aged 0–18 years using BW and height data from 27,440 hospital visits by 20,635 patients over one year. Methods The best fit of three nonlinear regression equations (third-order polynomial, Meeh-type, and modified Boyd self-adjusting-type) to a plot of the calculated Mosteller BSA values versus BW was then investigated. The correlation between the BSA values estimated by these equations and the Mosteller BSA values was established by the Spearman rank correlation test. Bias and precision were evaluated as outlined by Sheiner and Beal. Measured and estimated BSA values were compared using the Eksborg plot. Results The estimated BSA values from all three equations and the BSA values from the Mosteller equation were closely correlated ( P < .0001). The third-order polynomial and Meeh-type equations overestimated BSA by 0.13% and 0.40%, respectively, while the Boyd self-adjusted-type equation underestimated BSA by 0.060%. For the entire pediatric population, the best fit was obtained with the Meeh-type equation: 99.2% of the Meeh/Mosteller BSA ratios were within the range of 0.9–1.1 when compared with 98.3% and 97.2% for the polynomial and Boyd-type equations, respectively. Conclusion A single Meeh-type equation can be used to predict the results of Mosteller equation when H is not available with high precision and accuracy in children aged 0–18 years, including term neonates. We now plan to include the results of this study in CPOE systems in Sweden to improve drug dosage in all children.

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Dosing of chemotherapy in obese and cachectic patients: results of a national survey

Abstract: Dose adjustments are more frequent in obese patients than in cachectic patients. In cancer oncology patients, dose is adjusted mainly by hematology and hematopoietic cell transplant teams. Capping BSA is the most frequent strategy, followed by calculating actual body weight.

Cited by 5 publications

References 22 publications

A high BMI is a risk factor in younger patients with de novo acute myelogenous leukemia

A high BMI is a risk factor in younger patients with de novo acute myelogenous leukemia

Variability of carboplatin dose calculation methods in Spain

Estimation of body surface area in neonates, infants, and children using body weight alone

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