| Guideline question |
- How should antineoplastic doses be determined in obese adults?
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| Target population |
- Obese adults who will receive systemic antineoplastic therapies (chemotherapy, immunotherapy, or targeted therapy).
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| Target audience |
- Medical oncologists, oncology nurses, nurse practitioners, physician assistants, oncology pharmacists, and patients with cancer.
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| Methods |
- An Expert Panel was convened to develop updated clinical practice guideline recommendations based on a systematic review of the medical literature.
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| Recommendations |
- Full weight-based dosing of cytotoxic chemotherapy should be offered regardless of obesity status (type: evidence-based; evidence quality: low; strength of recommendation: moderate).
- The Panel recommends limiting fixed dosing of chemotherapy to select cytotoxic agents (eg, bleomycin). Although 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 body surface area (BSA)-based dosing in terms of toxicity and efficacy (type: evidence-based; evidence quality: low; strength of recommendation: moderate).
- US Food and Drug Administration–approved prescribing information for checkpoint inhibitors should be used in all patients, regardless of obesity status (type: evidence-based; evidence quality: low; strength of recommendation: moderate).
- US Food and Drug Administration–approved prescribing information for targeted therapies should be used in all patients, regardless of obesity status (type: evidence-based; evidence quality: low; strength of recommendation: moderate).
- 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 (type: informal consensus; evidence quality: insufficient; strength of recommendation: weak).
- 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 (type: evidence-based; evidence quality: low; strength of recommendation: moderate).
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| Additional resources |
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| ASCO believes that cancer clinical trials are vital to inform medical decisions and improve cancer care, and that all patients should have the opportunity to participate. |
