University of Michigan, Ann Arbor, MI, USA.
J Clin Oncol. 2012 May 1;30(13):1553-61. doi: 10.1200/JCO.2011.39.9436. Epub 2012 Apr 2.
To provide recommendations for appropriate cytotoxic chemotherapy dosing for obese adult patients with cancer.
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.
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.
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.
为肥胖成年癌症患者提供适当细胞毒化疗剂量的建议。
美国临床肿瘤学会召集了医学和妇科肿瘤学、临床药理学、药代动力学和药物遗传学、生物统计学和患者代表方面的专家组成一个小组。对 1996 年至 2010 年间发表的英文文献进行了 MEDLINE 搜索，并对文献进行了系统回顾。大多数研究涉及乳腺癌、卵巢癌、结肠癌和肺癌。本指南不涉及新型靶向药物的剂量问题。
实践模式研究表明，多达 40%的肥胖患者接受的化疗剂量有限，而不是基于实际体重。基于实际体重，肥胖癌症患者的毒性或过量用药的担忧是没有根据的。
专家组建议对肥胖癌症患者使用全基于体重的细胞毒化疗剂量，特别是当治疗目标是治愈时。没有证据表明接受全基于体重剂量的肥胖患者的短期或长期毒性增加。大多数数据表明，给予全基于体重剂量的肥胖患者的骨髓抑制与给予全基于体重剂量的非肥胖患者相同或程度较轻。临床医生应采用与非肥胖患者相同的方式对肥胖患者的所有治疗相关毒性做出反应。很少有理由使用固定剂量化疗，但专家组确实建议为少数选定的药物进行固定剂量治疗。专家组建议进一步研究药代动力学和药物遗传学在指导肥胖癌症患者适当剂量方面的作用。
