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Medline ® Abstract for Reference 54

of 'Dosing of anticancer agents in adults'

Chemotherapy dosing strategies in the obese, elderly, and thin patient: results of a nationwide survey.
Field KM, Kosmider S, Jefford M, Michael M, Jennens R, Green M, Gibbs P
J Oncol Pract. 2008 May;4(3):108-13.
PURPOSE: Determining the optimal starting dose of chemotherapy (CHT) presents a considerable challenge when using body-surface area (BSA)-based dosing, particularly in obese, elderly, or thin patients. We sought to document the range of approaches employed when administering CHT to these patients.
METHODS: A questionnaire was developed by a panel of oncologists and mailed to all members of the Medical Oncology Group of Australia.
RESULTS: From 315 oncologists, 188 responded (response rate 59.7%). BSA-based dosing is standard practice for 176 (97.2%) of the responding oncologists. In the adjuvant disease setting, 23 (12.7%) use ideal rather than actual body weight (BW) to calculate BSA, or choose whichever is less. When treating obese patients, only 6.1% of respondents routinely use actual BW. Of the remainder, 69.5% either cap the dose at 2 m(2) or use ideal BW. In underweight patients, 95% (n = 171) routinely calculate BSA using actual BW. Forty one respondents (22.7%) routinely reduce dose in the fit elderly.
CONCLUSION: This analysis of BSA-based CHT dosing methods demonstrates significant variability in practice. Based on evidence from adjuvant studies showing that actual BSA-based dosing is desirable, a substantial number of Australian patients are being underdosed. Further education, together with ongoing research, is required to optimize individualized dosing for efficacy and tolerability.
Department of Medical Oncology, Western Hospital, Footscray; Peter MacCallum Cancer Centre, East Melbourne; Royal Melbourne Hospital, Victoria; and Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Australia.