Dosing Recommendations
ÎUse actual body weight when selecting cytotoxic chemotherapy doses (both IV and oral) regardless of obesity status and subject to comorbidities, and use full weight-based doses because selecting reduced doses may result in poorer disease-free and overall survival rates.
Note: There is no evidence that short- or long-term toxicity is increased among obese patients receiving full weight–based chemotherapy doses. Most data indicate that myelosuppression is the same or less pronounced among the obese than the non-obese administered full weight– based doses.
ÎUse full weight-based chemotherapy dosing for morbidly obese patients with cancer, particularly when the goal of treatment is cure, subject to appropriate consideration of other comorbid conditions.
Note: Data are extremely limited regarding optimal dose selection among the morbidly obese and other special subgroups. however, based on available information, it seems likely that the same principles regarding dose selection for obese patients apply to the morbidly obese. Selecting reduced doses in this setting may result in poorer disease-free and overall survival rates.
ÎClinicians should follow the same guidelines for dose reduction, regardless of obesity status, for all patients, depending on the type and severity of toxicity, any comorbid conditions, and whether the treatment intention is cure or palliation.
Note: There is no evidence to support the need for greater dose reductions for obese patients compared with non-obese patients. If a dose reduction is employed in response to toxicity, consideration should be given to the resumption of full weight–based doses for subsequent cycles, especially if a possible cause of toxicity (eg, impaired renal, hepatic function) has been resolved. The Panel recognizes the need for clinicians to exercise judgment when providing care for patients who have experienced grade 3 or 4 chemotherapy toxicity. The presence of obesity alone should not alter such clinical judgment.
ÎClinicians should consider fixed dosing only with select cytotoxic agents (eg, carboplatin, bleomycin).
Note: Based primarily on neurotoxicity concerns, vincristine is capped at a maximum dose of 2.0 mg when used as part of the CHOP (cyclophosphamide, hydroxydoxorubicin [doxorubicin], vincristine, prednisone) and CVP (cyclophosphamide, vincristine, prednisone) regimens.
ÎCalculate BSA using any of the standard formulae.
ÎThe key points and dosing recommendations are based on a evidence-based guideline with a systematic review of the literature, including randomized controlled trials, observational studies, and pharmacokinetic studies.
ÎDosing for novel targeted agents is not addressed in the guideline.
