Appropriate Systemic Therapy Dosing for Obese Adult Patients with Cancer

Publication Date: April 26, 2021
Last Updated: September 2, 2022

Treatment

Full weight-based dosing of cytotoxic chemotherapy should be offered regardless of obesity status. ( EB , L , M )
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The Panel recommends limiting fixed dosing of chemotherapy to select cytotoxic agents (e.g., bleomycin). While fixed dosing of other cytotoxic chemotherapeutic agents has been used in clinical trials, evidence remains limited that fixed dosing strategies are equivalent to weight- or BSA-based dosing in terms of toxicity and efficacy. ( EB , L , M )
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FDA-approved prescribing information for checkpoint inhibitors should be used in all patients, regardless of obesity status. ( EB , L , M )
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FDA-approved prescribing information for targeted therapies should be used in all patients, regardless of obesity status. ( EB , L , M )
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If an obese patient experiences high-grade toxicity from systemic antineoplastic therapy, clinicians should follow the same guidelines for dose reduction for all patients, regardless of obesity status. ( IC , Ins , W )
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The Panel recommends that BSA be calculated using any of the standard formulae. There is no evidence to support one formula for calculating BSA over another. ( EB , L , M )
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Recommendation Grading

Disclaimer

Overview

Title

Appropriate Systemic Therapy Dosing for Obese Adult Patients with Cancer

Authoring Organization

Publication Month/Year

April 26, 2021

Last Updated Month/Year

July 12, 2023

Document Type

Guideline

Country of Publication

US

Target Patient Population

Obese adults who will receive systemic antineoplastic therapies (chemotherapy, immunotherapy, or targeted therapy).

Target Provider Population

Medical oncologists, oncology nurses, nurse practitioners, physician assistants, oncology pharmacists, and patients with cancer.

Inclusion Criteria

Male, Female, Adult, Older adult

Health Care Settings

Ambulatory, Hospital, Outpatient

Intended Users

Nurse, nurse practitioner, physician, physician assistant

Scope

Management

Diseases/Conditions (MeSH)

D001835 - Body Weight

Keywords

obesity, overweight, weight based dosing, dosing

Source Citation

Griggs JJ, Bohlke K, Balaban EP, Dignam JJ, Hall ET, Harvey RD, Hecht DP, Klute KA, Morrison VA, Pini TM, Rosner GL, Runowicz CD, Shayne M, Sparreboom A, Turner S, Zarwan C, Lyman GH. Appropriate Systemic Therapy Dosing for Obese Adult Patients With Cancer: ASCO Guideline Update. J Clin Oncol. 2021 Jun 20;39(18):2037-2048. doi: 10.1200/JCO.21.00471. Epub 2021 May 3. PMID: 33939491.

Supplemental Methodology Resources

Data Supplement, Evidence Tables

Methodology

Number of Source Documents
105
Literature Search Start Date
November 1, 2010
Literature Search End Date
March 27, 2020