Appropriate chemotherapy dosing for obese adult patients with cancer

American Society of Clinical Oncology clinical practice guideline

Jennifer J. Griggs, Pamela B. Mangu, Holly Anderson, Edward Balaban, James J. Dignam, William M. Hryniuk, Vicki A. Morrison, T. May Pini, Carolyn D. Runowicz, Gary L. Rosner, Michelle Shayne, Alex Sparreboom, Lara E. Sucheston, Gary H. Lyman

Research output: Contribution to journalReview article

270 Citations (Scopus)

Abstract

Purpose: To provide recommendations for appropriate cytotoxic chemotherapy dosing for obese adult patients with cancer. Methods: The American Society of Clinical Oncology convened a Panel of experts in medical and gynecologic oncology, clinical pharmacology, pharmacokinetics and pharmacogenetics, and biostatistics and a patient representative. MEDLINE searches identified studies published in English between 1996 and 2010, and a systematic review of the literature was conducted. A majority of studies involved breast, ovarian, colon, and lung cancers. This guideline does not address dosing for novel targeted agents. Results: Practice pattern studies demonstrate that up to 40% of obese patients receive limited chemotherapy doses that are not based on actual body weight. Concerns about toxicity or overdosing in obese patients with cancer, based on the use of actual body weight, are unfounded. Recommendations: The Panel recommends that full weight-based cytotoxic chemotherapy doses be used to treat obese patients with cancer, particularly when the goal of treatment is cure. There is no evidence that short- or long-term toxicity is increased among obese patients receiving full weight-based doses. Most data indicate that myelosuppression is the same or less pronounced among the obese than the non-obese who are administered full weight-based doses. Clinicians should respond to all treatment-related toxicities in obese patients in the same ways they do for non-obese patients. The use of fixed-dose chemotherapy is rarely justified, but the Panel does recommend fixed dosing for a few select agents. The Panel recommends further research into the role of pharmacokinetics and pharmacogenetics to guide appropriate dosing of obese patients with cancer.

Original languageEnglish (US)
Pages (from-to)1553-1561
Number of pages9
JournalJournal of Clinical Oncology
Volume30
Issue number13
DOIs
StatePublished - May 1 2012

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Practice Guidelines
Drug Therapy
Neoplasms
Pharmacogenetics
Weights and Measures
Pharmacokinetics
Body Weight
Biostatistics
Patient Advocacy
Medical Oncology
Clinical Pharmacology
MEDLINE
Ovarian Neoplasms
Colonic Neoplasms
Lung Neoplasms
Guidelines
Breast Neoplasms
Therapeutics
Research

All Science Journal Classification (ASJC) codes

  • Oncology
  • Cancer Research

Cite this

Griggs, Jennifer J. ; Mangu, Pamela B. ; Anderson, Holly ; Balaban, Edward ; Dignam, James J. ; Hryniuk, William M. ; Morrison, Vicki A. ; Pini, T. May ; Runowicz, Carolyn D. ; Rosner, Gary L. ; Shayne, Michelle ; Sparreboom, Alex ; Sucheston, Lara E. ; Lyman, Gary H. / Appropriate chemotherapy dosing for obese adult patients with cancer : American Society of Clinical Oncology clinical practice guideline. In: Journal of Clinical Oncology. 2012 ; Vol. 30, No. 13. pp. 1553-1561.
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title = "Appropriate chemotherapy dosing for obese adult patients with cancer: American Society of Clinical Oncology clinical practice guideline",
abstract = "Purpose: To provide recommendations for appropriate cytotoxic chemotherapy dosing for obese adult patients with cancer. Methods: The American Society of Clinical Oncology convened a Panel of experts in medical and gynecologic oncology, clinical pharmacology, pharmacokinetics and pharmacogenetics, and biostatistics and a patient representative. MEDLINE searches identified studies published in English between 1996 and 2010, and a systematic review of the literature was conducted. A majority of studies involved breast, ovarian, colon, and lung cancers. This guideline does not address dosing for novel targeted agents. Results: Practice pattern studies demonstrate that up to 40{\%} of obese patients receive limited chemotherapy doses that are not based on actual body weight. Concerns about toxicity or overdosing in obese patients with cancer, based on the use of actual body weight, are unfounded. Recommendations: The Panel recommends that full weight-based cytotoxic chemotherapy doses be used to treat obese patients with cancer, particularly when the goal of treatment is cure. There is no evidence that short- or long-term toxicity is increased among obese patients receiving full weight-based doses. Most data indicate that myelosuppression is the same or less pronounced among the obese than the non-obese who are administered full weight-based doses. Clinicians should respond to all treatment-related toxicities in obese patients in the same ways they do for non-obese patients. The use of fixed-dose chemotherapy is rarely justified, but the Panel does recommend fixed dosing for a few select agents. The Panel recommends further research into the role of pharmacokinetics and pharmacogenetics to guide appropriate dosing of obese patients with cancer.",
author = "Griggs, {Jennifer J.} and Mangu, {Pamela B.} and Holly Anderson and Edward Balaban and Dignam, {James J.} and Hryniuk, {William M.} and Morrison, {Vicki A.} and Pini, {T. May} and Runowicz, {Carolyn D.} and Rosner, {Gary L.} and Michelle Shayne and Alex Sparreboom and Sucheston, {Lara E.} and Lyman, {Gary H.}",
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Griggs, JJ, Mangu, PB, Anderson, H, Balaban, E, Dignam, JJ, Hryniuk, WM, Morrison, VA, Pini, TM, Runowicz, CD, Rosner, GL, Shayne, M, Sparreboom, A, Sucheston, LE & Lyman, GH 2012, 'Appropriate chemotherapy dosing for obese adult patients with cancer: American Society of Clinical Oncology clinical practice guideline', Journal of Clinical Oncology, vol. 30, no. 13, pp. 1553-1561. https://doi.org/10.1200/JCO.2011.39.9436

Appropriate chemotherapy dosing for obese adult patients with cancer : American Society of Clinical Oncology clinical practice guideline. / Griggs, Jennifer J.; Mangu, Pamela B.; Anderson, Holly; Balaban, Edward; Dignam, James J.; Hryniuk, William M.; Morrison, Vicki A.; Pini, T. May; Runowicz, Carolyn D.; Rosner, Gary L.; Shayne, Michelle; Sparreboom, Alex; Sucheston, Lara E.; Lyman, Gary H.

In: Journal of Clinical Oncology, Vol. 30, No. 13, 01.05.2012, p. 1553-1561.

Research output: Contribution to journalReview article

TY - JOUR

T1 - Appropriate chemotherapy dosing for obese adult patients with cancer

T2 - American Society of Clinical Oncology clinical practice guideline

AU - Griggs, Jennifer J.

AU - Mangu, Pamela B.

AU - Anderson, Holly

AU - Balaban, Edward

AU - Dignam, James J.

AU - Hryniuk, William M.

AU - Morrison, Vicki A.

AU - Pini, T. May

AU - Runowicz, Carolyn D.

AU - Rosner, Gary L.

AU - Shayne, Michelle

AU - Sparreboom, Alex

AU - Sucheston, Lara E.

AU - Lyman, Gary H.

PY - 2012/5/1

Y1 - 2012/5/1

N2 - Purpose: To provide recommendations for appropriate cytotoxic chemotherapy dosing for obese adult patients with cancer. Methods: The American Society of Clinical Oncology convened a Panel of experts in medical and gynecologic oncology, clinical pharmacology, pharmacokinetics and pharmacogenetics, and biostatistics and a patient representative. MEDLINE searches identified studies published in English between 1996 and 2010, and a systematic review of the literature was conducted. A majority of studies involved breast, ovarian, colon, and lung cancers. This guideline does not address dosing for novel targeted agents. Results: Practice pattern studies demonstrate that up to 40% of obese patients receive limited chemotherapy doses that are not based on actual body weight. Concerns about toxicity or overdosing in obese patients with cancer, based on the use of actual body weight, are unfounded. Recommendations: The Panel recommends that full weight-based cytotoxic chemotherapy doses be used to treat obese patients with cancer, particularly when the goal of treatment is cure. There is no evidence that short- or long-term toxicity is increased among obese patients receiving full weight-based doses. Most data indicate that myelosuppression is the same or less pronounced among the obese than the non-obese who are administered full weight-based doses. Clinicians should respond to all treatment-related toxicities in obese patients in the same ways they do for non-obese patients. The use of fixed-dose chemotherapy is rarely justified, but the Panel does recommend fixed dosing for a few select agents. The Panel recommends further research into the role of pharmacokinetics and pharmacogenetics to guide appropriate dosing of obese patients with cancer.

AB - Purpose: To provide recommendations for appropriate cytotoxic chemotherapy dosing for obese adult patients with cancer. Methods: The American Society of Clinical Oncology convened a Panel of experts in medical and gynecologic oncology, clinical pharmacology, pharmacokinetics and pharmacogenetics, and biostatistics and a patient representative. MEDLINE searches identified studies published in English between 1996 and 2010, and a systematic review of the literature was conducted. A majority of studies involved breast, ovarian, colon, and lung cancers. This guideline does not address dosing for novel targeted agents. Results: Practice pattern studies demonstrate that up to 40% of obese patients receive limited chemotherapy doses that are not based on actual body weight. Concerns about toxicity or overdosing in obese patients with cancer, based on the use of actual body weight, are unfounded. Recommendations: The Panel recommends that full weight-based cytotoxic chemotherapy doses be used to treat obese patients with cancer, particularly when the goal of treatment is cure. There is no evidence that short- or long-term toxicity is increased among obese patients receiving full weight-based doses. Most data indicate that myelosuppression is the same or less pronounced among the obese than the non-obese who are administered full weight-based doses. Clinicians should respond to all treatment-related toxicities in obese patients in the same ways they do for non-obese patients. The use of fixed-dose chemotherapy is rarely justified, but the Panel does recommend fixed dosing for a few select agents. The Panel recommends further research into the role of pharmacokinetics and pharmacogenetics to guide appropriate dosing of obese patients with cancer.

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