Pharmacokinetics of cancer therapeutics and energy balance: the role of diet intake, energy expenditure, and body composition

Abstract

Energy balance accounts for an individual’s energy intake, expenditure, and storage. Each aspect of energy balance has implications for the pharmacokinetics of cancer treatments and may impact an individual’s drug exposure and subsequently its tolerance and efficacy. However, the integrated effects of diet, physical activity, and body composition on drug absorption, metabolism, distribution, and excretion are not yet fully understood. This review examines the existing literature on energy balance, specifically the role of dietary intake and nutritional status, physical activity and energy expenditure, and body composition on the pharmacokinetics of cancer therapeutics. As energy balance and pharmacokinetic factors can be influenced by age-related states of metabolism and comorbidities, this review also explores the age-related impact of body composition and physiologic changes on pharmacokinetics among pediatric and older adult populations with cancer.

Safety assessments and clinical features of PARP inhibitors from real-world data of Japanese patients with ovarian cancer

“…This discrepancy might be because the Japanese have a lower BMI than Westerners, which might be caused by their food habits. It has been reported that energy balance including body composition and nutritional status could influence on pharmacokinetics of cancer therapeutics 29 , and the habits may influence racial differences in these adverse effects. Nausea and fatigue can affect quality of life particularly if persistent, and it is therefore important to educate and inform the patient of these adverse effects, and proactive efforts should be taken to prevent and treat nausea.…”

Evaluation of the relationship of the amount of ascites as measured quantitatively using computed tomography with chemotherapy toxicity in patients with ovarian cancer

“…The sizes of parts of the body composition are associated with the distribution of the drug. Hydrophilic drugs are dispersed in non-fatty compartments while lipophilic drugs are dispersed in fatty compartments [13]. How the absorption, distribution and elimination of chemotherapeutics associated with ascites volume are affected in our daily practices and whether an appropriate plasma concentration is achieved or not has been a subject of interest.…”

Reference ranges for body composition indices by dual energy X-ray absorptiometry from the Bone Mineral Density in Childhood Study Cohort

“…In particular, body composition is useful for determining energy requirements because lean tissue is more metabolically active than adipose tissue [ 1 ], and quantifying fat mass (FM) aids in determining inadequate or excess energy stores [ 2 ]. In addition, measurement of lean and FM can be informative for determining medication doses [ 3 , 4 ], disease effects [ 5 , 6 ], and other types of biological research [ 7 ].…”