How to manage the obese patient with cancer
How to manage the obese patient with cancer
Purpose: Obesity (body mass index [BMI] ? 30 kg/m2) is common among patients with cancer. We reviewed management issues in the obese patient with cancer, focusing on how obesity influences treatment selection (including chemotherapy dosing), affects chemotherapy toxicity and surgical complications, and might be a treatment effect modifier.
Methods: The majority of evidence is drawn from observational studies and secondary analyses of trial data, typically analyzed in N × 3 BMI categories (normal weight, overweight, and obese) matrix structures. We propose a methodological framework for interpretation focusing on sample size and composition, nonlinearity, and unmeasured confounding.
Results: There is a common perception that obesity is associated with increased treatment-related toxicity. Accordingly, cytotoxic chemotherapy dose reduction is common in patients with elevated BMI. Contrary to this, there is some evidence that full dosing in obese patients does not result in increased toxicity. However, these data are from a limited number of regimens, and fail to fully capture cytotoxic drug pharmacodynamics and pharmacokinetic variability in obese patients. Among patients undergoing surgery, there is evidence that elevated BMI is associated with increased perioperative mortality and increased rates of infectious complications. A novel finding is that these relationships hold after surgery for malignancy, but not for benign indications. There are biologic plausibilities that obesity might be an effect modifier of treatment, but supporting evidence from clinical studies is inconsistent.
Conclusion: In line with the ASCO 2012 guidelines, chemotherapy dosing is probably best performed using actual body weight in obese patients. However, specific regimens known to be associated with increased toxicity in this group should be used with caution. There is no guidance on dose for obese patients treated with biologic agents. Currently, there are no specific recommendations for the surgical management of the obese patient with cancer.
4284-4294
Renehan, Andrew G.
79ffd621-ada7-4e39-8435-b5e8e624039e
Harvie, Michelle
5a044f8f-a21c-45ef-9d37-bbc5d70de6d0
Cutress, Ramsey I.
68ae4f86-e8cf-411f-a335-cdba51797406
Leitzmann, Michael
b41e9eec-5ae4-48bf-8475-62a7bb846786
Pischon, Tobias
ad6d4fcc-333a-4428-b69b-3d369f44d166
Howell, Sacha
1cf0dd04-ac56-4a7b-b066-ac241bab9d6d
Howell, Anthony
1a0a7e78-3d51-4e76-8cd5-bd46cb90d588
10 December 2016
Renehan, Andrew G.
79ffd621-ada7-4e39-8435-b5e8e624039e
Harvie, Michelle
5a044f8f-a21c-45ef-9d37-bbc5d70de6d0
Cutress, Ramsey I.
68ae4f86-e8cf-411f-a335-cdba51797406
Leitzmann, Michael
b41e9eec-5ae4-48bf-8475-62a7bb846786
Pischon, Tobias
ad6d4fcc-333a-4428-b69b-3d369f44d166
Howell, Sacha
1cf0dd04-ac56-4a7b-b066-ac241bab9d6d
Howell, Anthony
1a0a7e78-3d51-4e76-8cd5-bd46cb90d588
Renehan, Andrew G., Harvie, Michelle, Cutress, Ramsey I., Leitzmann, Michael, Pischon, Tobias, Howell, Sacha and Howell, Anthony
(2016)
How to manage the obese patient with cancer.
Journal of Clinical Oncology, 34 (35), .
(doi:10.1200/JCO.2016.69.1899).
(PMID:27903151)
Abstract
Purpose: Obesity (body mass index [BMI] ? 30 kg/m2) is common among patients with cancer. We reviewed management issues in the obese patient with cancer, focusing on how obesity influences treatment selection (including chemotherapy dosing), affects chemotherapy toxicity and surgical complications, and might be a treatment effect modifier.
Methods: The majority of evidence is drawn from observational studies and secondary analyses of trial data, typically analyzed in N × 3 BMI categories (normal weight, overweight, and obese) matrix structures. We propose a methodological framework for interpretation focusing on sample size and composition, nonlinearity, and unmeasured confounding.
Results: There is a common perception that obesity is associated with increased treatment-related toxicity. Accordingly, cytotoxic chemotherapy dose reduction is common in patients with elevated BMI. Contrary to this, there is some evidence that full dosing in obese patients does not result in increased toxicity. However, these data are from a limited number of regimens, and fail to fully capture cytotoxic drug pharmacodynamics and pharmacokinetic variability in obese patients. Among patients undergoing surgery, there is evidence that elevated BMI is associated with increased perioperative mortality and increased rates of infectious complications. A novel finding is that these relationships hold after surgery for malignancy, but not for benign indications. There are biologic plausibilities that obesity might be an effect modifier of treatment, but supporting evidence from clinical studies is inconsistent.
Conclusion: In line with the ASCO 2012 guidelines, chemotherapy dosing is probably best performed using actual body weight in obese patients. However, specific regimens known to be associated with increased toxicity in this group should be used with caution. There is no guidance on dose for obese patients treated with biologic agents. Currently, there are no specific recommendations for the surgical management of the obese patient with cancer.
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Accepted/In Press date: 26 September 2016
e-pub ahead of print date: 7 November 2016
Published date: 10 December 2016
Organisations:
Cancer Sciences
Identifiers
Local EPrints ID: 403703
URI: http://eprints.soton.ac.uk/id/eprint/403703
ISSN: 1527-7755
PURE UUID: de04bf84-6d4c-474d-a9c6-68caaf8ec69d
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Date deposited: 09 Dec 2016 10:05
Last modified: 15 Mar 2024 06:08
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Contributors
Author:
Andrew G. Renehan
Author:
Michelle Harvie
Author:
Michael Leitzmann
Author:
Tobias Pischon
Author:
Sacha Howell
Author:
Anthony Howell
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