Title:Chemotherapy and Anticancer Drugs Adjustment in Obesity: A Narrative
Review
Volume: 30
Issue: 9
关键词:
肥胖，药代动力学，癌症化疗，抗肿瘤，剂量调整，体表面积，儿科，实际总体重，理想体重。
摘要:
Background: Obese individuals have higher rates of cancer incidence and cancer-
related mortality. The worse chemotherapy outcomes observed in this subset of patients
are multifactorial, including the altered physiology in obesity and its impact on
pharmacokinetics, the possible increased risk of underdosing, and treatment-related toxicity.
Aims: The present review aimed to discuss recent data on physiology, providing just an
overall perspective and pharmacokinetic alterations in obesity concerning chemotherapy.
We also reviewed the controversies of dosing adjustment strategies in adult and pediatric
patients, mainly addressing the use of actual total body weight and ideal body weight.
Methods: This narrative review tried to provide the best evidence to support antineoplastic
drug dosing strategies in children, adolescents, and adults.
Results: Cardiovascular, hepatic, and renal alterations of obesity can affect the distribution,
metabolism, and clearance of drugs. Anticancer drugs have a narrow therapeutic
range, and variations in dosing may result in either toxicity or underdosing. Obese patients
are underrepresented in clinical trials that focus on determining recommendations
for chemotherapy dosing and administration in clinical practice. After considering associated
comorbidities, the guidelines recommend that chemotherapy should be dosed according
to body surface area (BSA) calculated with actual total body weight, not an estimate
or ideal weight, especially when the intention of therapy is the cure.
Conclusion: The actual total body weight dosing appears to be a better approach to dosing
anticancer drugs in both adults and children when aiming for curative results, showing
no difference in toxicity and no limitation in treatment outcomes compared to adjusted
doses.
