University of Michigan, Ann Arbor, MI.
American Society of Clinical Oncology, Alexandria, VA.
J Clin Oncol. 2021 Jun 20;39(18):2037-2048. doi: 10.1200/JCO.21.00471. Epub 2021 May 3.
To provide recommendations for appropriate dosing of systemic antineoplastic agents in obese adults with cancer.
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.
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.
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.
为癌症肥胖成人提供系统抗肿瘤药物适当剂量的建议。
系统回顾了 2010 年 11 月 1 日至 2020 年 3 月 27 日期间发表的关于癌症肥胖成人化疗、免疫治疗和靶向治疗剂量的随机对照试验、荟萃分析或队列研究文献，收集证据。在 PubMed 和 Cochrane Library 上进行了检索。美国临床肿瘤学会召集了一个专家小组来审查证据并制定建议。
有 60 项研究，主要是回顾性研究，被纳入了综述。总的来说，证据支持了之前的发现，即肥胖成年患者能够耐受完整的、基于身体大小的化疗剂量，与非肥胖患者一样。关于肥胖患者安全性和疗效的靶向治疗和免疫治疗剂量的研究较少。
专家组继续建议为癌症肥胖成人使用完整的、基于体重的细胞毒性化疗剂量。本指南的新版本新增了一个建议，即应向癌症肥胖成人提供完整的、批准的免疫治疗和靶向治疗剂量。如果出现毒性，专家组的共识是，应类似地对肥胖和非肥胖患者进行系统抗肿瘤治疗的剂量调整。未来研究的重要领域包括肌肉减少症和其他身体成分测量对最佳抗肿瘤剂量的影响，以及基于药代动力学或药效学因素的更定制剂量。更多信息可在 www.asco.org/supportive-care-guidelines 上获取。
