Obesity and chemotherapy administration: between empiric and mathematic method review

Figures & data

Table 1. Summarizing studies on body surface area adjustment in obese patients with breast cancer treated with chemotherapy.

	Nature of study	Inclusion criteria	Number of obese patients enrolled	Chemotherapy regimen	Method of BSA adjustement	Percentage of patients with adjusted BSA	Results	Study reference
Breast cancer	Retrospective	BMI ≥ 30 Adjuvant chemotherapy	555	Epirubicinx3 +paclitaxelx3+cyclophosphamidex3 (iddETC regimen) or epirubicin + cyclophosphamide + paclitaxel + capecitabine (EC-TX regimen)	Ideal weight or capping to 2m^2	31%	Higher rate of severe toxicities (real BSA)	21
	Retrospective	Early breast cancer	79	Neoadjuvant/adjuvant chemotherapy (FEC-T,FEC,ECaP)	Chemotherapy dose lower than expected	–	Dose capping is associated with lower rate of febrile neutropenia	23
	Retrospective	Non metastatic breast cancer	114	5-fluorouracil + epirubicin + cyclophosphamide followed by docetaxel (FEC-T), or Doxorubicin + cyclophosphamide + docetaxel + trastuzumab(ACTH).	Capped BSA	15.8%	No significant increase toxicities	24
	Retrospective	Adjuvant chemotherapy	108	5-fluorouracil + epirubicin + cyclophosphamide ( FEC)	–	–	No significant increase toxicities	25
	Retrospective	Premenopausal patients with node-positive breast cancer	152	(cyclophosphamide, methotrexate and 5-fluorouracil).	Lower chemotherapy dose (85% of expected dose)	39% of patients receive lower chemotherapy doses	No significant increase toxicities Significant worse outcome for the ER-negative cohort	25
	Retrospective	Non metastatic pT1-4 node positive breast cancer	368 (Total population)	CMF regimen (cyclophosphamide, methotrexate	Drug doses were calculated on BSA basis	–	No reduction of chemotherapy doses because of obesity	26
	Retrospective	Stage II breast cancer patients with positive regional lymph nodes	568	Adjuvant cyclophosphamide, doxorubicin, and fluorouracil (CAF)	Actual Body Weight	–	Dosing chemotherapy according to actual body weight did not induce substantially higher risk of toxicity	20

Table 2. Table summarizing studies on body surface area adjustment in obese patients with colon cancer treated with chemotherapy.

Solid tumors	Nature of study	Inclusion criteria	Number of obese patients enrolled	Chemotherapy regimen	Method of BSA adjustement	Percentage of patients with adjusted BSA	Results	Study reference
Colon cancer	Retrospective phase III PETACC 3 trial	Stage III colon cancer	280	Leucovorin 5-FU (LV5FU2) or LV5FU2 plus irinotecan	Dose capping at 2 m2	16,10%	Dose reduction strategy should be avoid in adjuvant treatment of colon cancer	29
	Retrospective	Advanced colorectal cancer	870	Chemotherapy regimen is defined in Focus, Focus2 and coin trials	Dose reduction (5% below)	54%	Do not support the policy of reducing chemotherapy doses for obese patients with colorectal cancer	30
	Retrospective	Stage II and III rectal cancer	306	Chemotherapy regimen is defined in Trial 0114	Actual Body Weight	–	obese patients experience less toxicity associated with adjuvant chemoradiotherapy, suggesting that actual body weight dosing of fluorouracil for obese patients is justified	31
	Retrospective	Women with Stage II–III colon carcinoma	600	Chemotherapy regimen is defined in 0089 treatment trial	–	–	obesity was not associated with any increase in chemotherapy-related toxicity	32

Table 3. Table summarizing studies on body surface area adjustment in obese patients with ovarian and endometrial cancers treated with chemotherapy.

Solid tumors	Nature of study	Inclusion criteria	Number of obese patients enrolled	Chemotherapy regimen	Method of BSA adjustment	Percentage of patients with adjusted BSA	Results	Study reference
Ovarian and endometrial cancers	Retrospective	Endometrial and ovarian cancer	59	Paclitaxel and carboplatin	Dose capping at 2 m2	15%	No statistically significant differences in rates of toxicity or dose modification	33
	Retrospective	FIGO Stage III/IV serous ovarian cancer	70	Carboplatin AUC 5 and paclitaxel	Dose reduction (5% below)	66%	Reduced doses may impact on PFS in patients with advanced serous ovarian cancer.	34
	Retrospective	Gynecologic malignancy	75	Gemcitabine, liposomal doxorubicin and paclitaxel	Dose capping at 2 m2	–	Gynecologic cancer patients with BSA ≥2m2 treatedwithWB chemotherapy had no increase in hematologic or non-hematologic toxicities when compared to controls	35
	Retrospective	Epithelial ovarian cancer	70	Cisplatin and paclitaxel or carboplatin in combination with paclitaxel	–	–	Obese ovarian cancer patients treated with carboplatin experience substantially less toxicity than normal weight women. The lower toxicity suggests that obese patients may be receiving a substandard drug dose	36
	Retrospective	Ovarian cancer	129	Docetaxel/carboplatin or Paclitaxel/carboplatin	–	0%	Obese patients with epithelial ovarian cancer do not have a poorer prognosis, provided that they receive optimal doses of chemotherapy based on measured GFR and actual body weight	37

Table 4. Table summarizing studies on body surface area adjustment in obese patients with lung cancer treated with chemotherapy.

Solid tumors	Nature of study	Inclusion criteria	Number of obese patients enrolled	Chemotherapy regimen	Method of BSA adjustement	Percentage of patients with adjusted BSA	Results	Study reference
Lung cancer	Retrospective	Small-cell lung cancer	262 ( Total patients)	Cyclophosphamide-based regimen or etoposide and cisplatin plus twice-daily chest radiotherapy.	Actual body weight	–	Obesity at the start of treatment was not associated with increased toxicity from treatment or a shortened survival. No support for empiric chemotherapy dose reductions based on ideal body weight was evident from this study.	38

Table 5. Table summarizing studies on body surface area adjustment in obese patients with prostate cancer treated with chemotherapy.

Solid tumors	Nature of study	Inclusion criteria	Number of obese patients enrolled	Chemotherapy regimen	Method of BSA adjustement	Percentage of patients with adjusted BSA	Results	Study reference
castration-resistant metastatic prostate cancer	Retrospective	Metastatic disease at the time of initiation of docetaxel chemotherapy	118	Docetaxel administered intravenously every 3 weeks, or weekly in the break week(s)	Discretion of the treating oncologist	34.5% (reduced doses)	Empirical dose reduction is this population is not warranted	39