Dosing chemotherapy in obese patients: Actual versus assigned body surface area (BSA)

Hunter, Rodney J.; Navo, Marisa A.; Thaker, Premal H.; Bodurka, Diane C.; Wolf, Judith K.; Smith, Judith A.

doi:10.1016/j.ctrv.2008.07.005

Cited by 90 publications

(60 citation statements)

References 47 publications

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“…Due to concerns for the development of severe toxicities, clinicians are hesitant to use actual body weight (ABW) to calculate chemotherapy dosages in obese patients, and up to 40% receive reduced chemotherapy dosages, often based on ideal body weight or an artificial BSA "cap" of 2 m 2 [6,7,9].…”

Section: Introductionmentioning

confidence: 99%

Outcomes in obese and overweight acute myeloid leukemia patients receiving chemotherapy dosed according to actual body weight

et al. 2013

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Cytotoxic chemotherapy dosages are traditionally calculated according to body surface area (BSA). No guidelines exist for chemotherapy dosing of acute myeloid leukemia (AML) patients at extremes of weight. We investigated the efficacy and safety of chemotherapy dosed according to BSA based on actual body weight (ABW) among under/normal weight, overweight, and obese AML patients. AML patients (excluding acute promyelocytic leukemia) treated with anthracycline and cytarabine-based remission induction chemotherapy from 2002 to 2009 at Cleveland Clinic were divided into three body mass index (BMI) groups: under/normal weight (BMI 24.9), overweight (BMI 25.0-29.9), and obese (BMI 30.0). Among 247 AML patients, 81 (33%) were under/normal weight, 81 (33%) were overweight, and 85 (34%) were obese. Complete remission (CR) rates were similar among these groups (69.1, 79.0, and 76.5%, respectively; P 5 0.321), as was median survival (10.7, 16.7, and 14.2 months, respectively, P 5 0.352) and 30-day mortality (3.7, 2.5, 7.1%, respectively, P 5 0.331). There was no difference among groups in days to neutrophil or platelet recovery, hospitalization days for induction chemotherapy, and bacteremia. After adjustment for confounders (age, sex, BMI, white blood cells, cytogenetic risk, etiology, and bacteremia), overall survival was significantly shorter for normal weight compared to overweight (P 5 0.006) and obese (0.038) patients. Response rates and adverse events were not significantly different among AML patients of all weight classes when induction chemotherapy was dosed according to ABW. Induction chemotherapy in these patients can be safely dosed using ABW. Am. J.

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Section: Introductionmentioning

confidence: 99%

Outcomes in obese and overweight acute myeloid leukemia patients receiving chemotherapy dosed according to actual body weight

et al. 2013

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“…1 Medication pharmacokinetics are altered in obese patients, largely due to increased adipose tissue, various comorbidities and altered organ function, leading to differences in volume of distribution, drug clearance and protein binding. 2,3 Cytotoxic chemotherapy is traditionally dosed using body surface area or body weight; however, in this era of increasing obesity, clinicians are hesitant to use actual body weight to calculate chemotherapy doses because of concerns of overdose and the potential for severe toxicity. 4 These concerns have led to practices such as dose capping body surface area at a maximum of 2 m 2 , or using ideal or adjusted body weight in weight-based dosing of obese patients.…”

Section: Introductionmentioning

confidence: 99%

“…Given the delicate balance between efficacy and toxicity, numerous studies evaluating dose-capping and dose-adjustment practices have indicated that they may compromise outcomes in obese patients receiving chemotherapy. 2,4,5 Recognizing the problems that the extremes of body size incur, the American Society of Clinical Oncology published a clinical practice guideline supporting the use of actual body weight when calculating doses for most chemotherapy agents. 6 However, these recommendations were based on results from studies conducted in solid tumor malignancies.…”

Section: Introductionmentioning

confidence: 99%

Outcomes after autologous SCT in lymphoma patients grouped by weight

Lau

Weber

Earl

et al. 2015

Bone Marrow Transplant

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Obesity continues to be an increasing global health issue contributing to the complexity of chemotherapy dosing in the field of SCT. Investigation into the optimal dosing weight used to calculate chemotherapy doses in obese patients undergoing SCT is limited and inconclusive. Our single-center, retrospective study compared safety and efficacy outcomes by body mass index (BMI) for 476 adult lymphoma patients who underwent auto-SCT with a myeloablative chemotherapeutic regimen of BU, CY and etoposide dosed using adjusted body weight. Three weight groups categorized based on BMI were defined: normal/underweight ⩽ 24.9 kg/m 2 , overweight 25-29.9 kg/m 2 and obese ⩾ 30 kg/m 2 . Severity of mucositis, incidence of secondary malignancy, incidence of bacteremia and median hospital length of stay did not differ among the groups. The median times to absolute neutrophil count and platelet recovery were 10 days (P = 0.75) and 14 days (P = 0.17), respectively. Obese patients had a lower 100-day mortality compared with other weight groups, although this did not translate into an OS benefit. OS and disease relapse were similar among the groups. Our study demonstrates that use of adjusted body weight to calculate chemotherapy doses does not negatively have an impact on outcomes in obese patients undergoing auto-SCT with BU, CY and etoposide.

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“…Specifically, body mass index (BMI) has been widely evaluated due to its ability to normalize for patient height (9)(10)(11)(12)(13)(14). Another metric, body surface area (BSA), has been incorporated clinically to personalize chemotherapeutic doses based on patient size and visceral fat content (15)(16)(17). A relatively new metric, total psoas area (TPA), has shown promise as an additional proxy for nutritional status; specifically, low TPA, or sarcopenia, has been used in place of deficient nutritional status in gastrointestinal cancers (18,19).…”

Section: Introductionmentioning

confidence: 99%

Impact of sarcopenia in borderline resectable and locally advanced pancreatic cancer patients receiving stereotactic body radiation therapy

Jin¹,

Mellon²,

Frakes³

et al. 2018

J. Gastrointest. Oncol.

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Background: Total psoas area (TPA), a marker of sarcopenia, has been used as an independent predictor of clinical outcomes in gastrointestinal (GI) cancers as a proxy for frailty and nutritional status. Our study aimed to evaluate whether TPA, in contrast to traditional measurements of nutrition like body mass index (BMI) and body surface area (BSA), was predictive of outcomes in borderline resectable pancreatic cancer (BRPC) and locally advanced pancreatic cancer (LAPC) patients receiving stereotactic body radiation therapy (SBRT). Methods: Retrospective analysis of an institutional review board approved database of 222 BRPC and LAPC treated with SBRT from 2009-2016 yielded 183 patients that met our selection criteria of pre-SBRT computed tomography (CT) imaging with an identifiable L4 vertebra. Once the L4 vertebral level was identified, the bilateral psoas muscles were manually contoured. This area was normalized by patient height, with units described in mm 2 /m 2 . Receiver operating characteristic (ROC) curves were generated for TPA, BMI, and BSA to elicit clinically relevant cutoffs. Regression and Kaplan-Meier analyses were used to correlate toxicity with survival functions.Results: Low TPA (OR =1.903, P=0.036) was predictive of acute toxicities, and only TPA was predictive of Grade 3 or higher acute toxicities (OR =10.24, P=0.007). Both findings were independent of tumor resectability. Pain (P=0.003), fatigue (P=0.040), and nausea (P=0.039) were significantly associated with low TPA. No association was identified between any measurement of nutritional status and the development of late toxicities, overall survival, local progression or local recurrence. However, BRPC patients survived longer (median =21.98 months) than their LAPC (median =16.2 months) counterparts (P=0.002), independent of nutritional status. Conclusions: TPA measurement is readily available and more specific than BMI or BSA as a predictor of acute radiotoxic complications following SBRT in BRPC/LAPC patients. A TPA of <500 mm 2 /m 2 is a clinically relevant cutoff that can direct physicians to address expected complications of pain, fatigue, and nausea. However, tumor resectability remains as the only predictor of overall survival in this cohort.

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Dosing chemotherapy in obese patients: Actual versus assigned body surface area (BSA)

Cited by 90 publications

References 47 publications

Outcomes in obese and overweight acute myeloid leukemia patients receiving chemotherapy dosed according to actual body weight

Outcomes in obese and overweight acute myeloid leukemia patients receiving chemotherapy dosed according to actual body weight

Outcomes after autologous SCT in lymphoma patients grouped by weight

Impact of sarcopenia in borderline resectable and locally advanced pancreatic cancer patients receiving stereotactic body radiation therapy

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