Retrospective and prospective preclinical and clinical data have demonstrated an association between
chemotherapy dose intensity and both clinical efficacy and toxicity. The optimum tolerable and effective dose and schedule of chemotherapeutic agents is based on data from dose-finding studies and early clinical trials. There is considerable evidence that reductions in the recommended dose intensity often occurs in actual clinical practice, particularly among
overweight and obese patients with
cancer. With increasing rates of
obesity, and variation and uncertainty about appropriate dosing of
chemotherapy in obese patients, ASCO has generated clinical practice guidelines for appropriate
chemotherapy dosing for obese adult patients with
cancer. Without evidence of any increase in treatment-related toxicity among obese patients receiving
chemotherapy, the guidelines recommend that, after considering any accompanying comorbidities,
chemotherapy dosing should be calculated based on body surface area using actual weight, rather than an estimate or idealization of weight. While further research is needed, pharmacokinetic studies support the use of actual
body weight to calculate
chemotherapy doses for most
chemotherapy drugs in obese patients. We highlight the issue of
chemotherapy dosing in this population, how a more personalized approach can be achieved, as well as discussing areas for further research.