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Practice Guideline
. 2021 Jun 20;39(18):2037-2048.
doi: 10.1200/JCO.21.00471. Epub 2021 May 3.

Appropriate Systemic Therapy Dosing for Obese Adult Patients With Cancer: ASCO Guideline Update

Jennifer J Griggs  1 , Kari Bohlke  2 , Edward P Balaban  3 , James J Dignam  4 , Evan T Hall  5 , R Donald Harvey  6 , Diane P Hecht  7 , Kelsey A Klute  8 , Vicki A Morrison  9 , T May Pini  10 , Gary L Rosner  11 , Carolyn D Runowicz  12 , Michelle Shayne  13 , Alex Sparreboom  14 , Sophia Turner  15 , Corrine Zarwan  16 , Gary H Lyman  5
Affiliations
Practice Guideline

Appropriate Systemic Therapy Dosing for Obese Adult Patients With Cancer: ASCO Guideline Update

Jennifer J Griggs et al. J Clin Oncol. .

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.

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Conflict of interest statement

Jennifer J. GriggsEmployment: Anglona CorporationStock and Other Ownership Interests: Anglona Corporation James J. DignamConsulting or Advisory Role: Merck, Celgene, Northwest Biotherapeutics Evan T. HallTravel, Accommodations, Expenses: NovartisOther Relationship: Cancer Support CommunityUncompensated Relationships: Bristol Myers SquibbOpen Payments Link: https://openpaymentsdata.cms.gov/physician/1368769 R. Donald HarveyConsulting or Advisory Role: GlaxoSmithKlineResearch Funding: AstraZeneca, Calithera Biosciences, Pfizer, AbbVie, Boston Biomedical, Genmab, Nektar, Rgenix, Xencor, Meryx Pharmaceuticals, Abbisko, Actuate Therapeutics, Alkermes, Amgen, Bayer, Fujifilm, GlaxoSmithKline, Infinity Pharmaceuticals, InhibRx, Merck, Mersana, Puma Biotechnology, RAPT Therapeutics, Seattle Genetics, Sutro Biopharma, Takeda Kelsey A. KluteConsulting or Advisory Role: Cancer Expert Now Vicki A. MorrisonConsulting or Advisory Role: Celgene, MerckSpeakers' Bureau: Celgene, Seattle GeneticsPatents, Royalties, Other Intellectual Property: UpToDate author (Pathogenesis of infection in CLL pts, prevention of infection in CLL pts) T. May PiniEmployment: Flatiron Health, Premier IncStock and Other Ownership Interests: Roche, Premier Inc Gary L. RosnerStock and Other Ownership Interests: Johnson & Johnson, WalgreensHonoraria: NovartisConsulting or Advisory Role: Novartis, Medicago R&D IncTravel, Accommodations, Expenses: NovartisOther Relationship: Novartis Carolyn D. RunowiczHonoraria: UpToDatePatents, Royalties, Other Intellectual Property: Patent for High efficacy anticancer drug delivery, release and nanoscale heat treatment of cancerous cells Michelle ShayneResearch Funding: BeyondSpring Pharmaceuticals Sophia TurnerEmployment: IQVIA Corrine ZarwanConsulting or Advisory Role: Perceptive Informatics, Revere Pharmaceuticals, Advance MedicalResearch Funding: Tesaro, Novartis, Merrimack, EMD Serono Gary H. LymanConsulting or Advisory Role: G1 Therapeutics, Sandoz-Novartis, Samsung Bioepis, BeyondSpring Pharmaceuticals, TevaResearch Funding: AmgenTravel, Accommodations, Expenses: BayerNo other potential conflicts of interest were reported.

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