Jennifer J Griggs1, Kari Bohlke2, Edward P Balaban3, James J Dignam4, Evan T Hall5, R Donald Harvey6, Diane P Hecht7, Kelsey A Klute8, Vicki A Morrison9, T May Pini10, Gary L Rosner11, Carolyn D Runowicz12, Michelle Shayne13, Alex Sparreboom14, Sophia Turner15, Corrine Zarwan16, Gary H Lyman5. 1. University of Michigan, Ann Arbor, MI. 2. American Society of Clinical Oncology, Alexandria, VA. 3. Penn State Cancer Institute, Hershey, PA. 4. University of Chicago, Chicago, IL. 5. Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA. 6. Emory University, Atlanta, GA. 7. University of Texas MD Anderson Cancer Center, Houston, TX. 8. University of Nebraska Medical Center, Omaha, NE. 9. University of Minnesota Hennepin County Medical Center, Minneapolis, MN. 10. Flatiron Health, Inc, New York, NY. 11. Johns Hopkins University, Baltimore, MD. 12. Herbert Wertheim College of Medicine, Florida International University, Miami, FL. 13. University of Rochester Medical Center, Rochester, NY. 14. Ohio State University, Columbus, OH. 15. Independent Cancer Patient's Voice, London, UK. 16. Lahey Hospital and Medical Center, Burlington, MA.
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.
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 obesepatients. 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.
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