Una de las dudas que me surgía personalmente a mí a la hora de validar las quimioterapias pautadas en oncología era qué hacer en caso de pacientes obesos. ¿Se debe utilizar el peso real? ¿o bien, el peso ideal ajustado? Surgen dudas respecto a un incremento de toxicidad o bien a una falta de eficacia: ¿se causará un incremento en la toxicidad y en las complicaciones? ¿nos quedaremos corto con la eficacia?
Y aunque ya tiene unos meses, este artículo ayuda a resolver las dudas planteadas. Se trata de las guías clínicas de la ASCO para la dosificación de citostáticos en paciente obeso. Os adjunto el abstract, y el link al artículo:
Jennifer J. Griggs et al. Appropriate Chemotherapy Dosing for Obese Adult Patients With Cancer: American Society of Clinical Oncology Clinical Practice Guideline. J Clin Oncol. 2012 May 1;30(13):1553-61. Epub 2012 Apr 2.
Purpose
To provide recommendations for appropriate cytotoxic chemotherapy dosing for obese adult patients with cancer.
Methods
The American Society of Clinical Oncology convened a Panel of experts in medical and gynecologic oncology, clinical pharmacology, pharmacokinetics and pharmacogenetics, and biostatistics and a patient representative. MEDLINE searches identified studies published in English between 1996 and 2010, and a systematic review of the literature was conducted. A majority of studies involved breast, ovarian, colon, and lung cancers. This guideline does not address dosing for novel targeted agents.
Results
Practice pattern studies demonstrate that up to 40% of obese patients receive limited chemotherapy doses that are not based on actual body weight. Concerns about toxicity or overdosing in obese patients with cancer, based on the use of actual body weight, are unfounded.
Recommendations
The Panel recommends that full weight–based cytotoxic chemotherapy doses be used to treat obese patients with cancer, particularly when the goal of treatment is cure. There is no evidence that shortor long-term toxicity is increased among obese patients receiving full weight–based doses. Most data indicate that myelosuppression is the same or less pronounced among the obese than the non-obese who are administered full weight–based doses. Clinicians should respond to all treatment-related toxicities in obese patients in the same ways they do for non-obese patients. The use of fixed-dose chemotherapy is rarely justified, but the Panel does recommend fixed dosing for a few select agents. The Panel recommends further research into the role of pharmacokinetics and pharmacogenetics to guide appropriate dosing of obese patients with cancer
To provide recommendations for appropriate cytotoxic chemotherapy dosing for obese adult patients with cancer.
Methods
The American Society of Clinical Oncology convened a Panel of experts in medical and gynecologic oncology, clinical pharmacology, pharmacokinetics and pharmacogenetics, and biostatistics and a patient representative. MEDLINE searches identified studies published in English between 1996 and 2010, and a systematic review of the literature was conducted. A majority of studies involved breast, ovarian, colon, and lung cancers. This guideline does not address dosing for novel targeted agents.
Results
Practice pattern studies demonstrate that up to 40% of obese patients receive limited chemotherapy doses that are not based on actual body weight. Concerns about toxicity or overdosing in obese patients with cancer, based on the use of actual body weight, are unfounded.
Recommendations
The Panel recommends that full weight–based cytotoxic chemotherapy doses be used to treat obese patients with cancer, particularly when the goal of treatment is cure. There is no evidence that shortor long-term toxicity is increased among obese patients receiving full weight–based doses. Most data indicate that myelosuppression is the same or less pronounced among the obese than the non-obese who are administered full weight–based doses. Clinicians should respond to all treatment-related toxicities in obese patients in the same ways they do for non-obese patients. The use of fixed-dose chemotherapy is rarely justified, but the Panel does recommend fixed dosing for a few select agents. The Panel recommends further research into the role of pharmacokinetics and pharmacogenetics to guide appropriate dosing of obese patients with cancer
Espero que os resulte de utilidad!
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