4CPS-100 Anthracycline dosing in obese adult patients: a systematic review

• Published in: European journal of hospital pharmacy. Science and practice 2020-03, Vol.27 (Suppl 1), p.A94-A94
• Main Authors: Tapia, B, Casas, A, Torroba, B, Fraile, C, Gutierrez, A, Fernandez, B, Serrano-Alonso, M, García Del Barrio, MA
• Format: Article
• Language: English
• Subjects: Body mass index; Breast cancer; Chemotherapy; Obesity; Systematic review
• ISSN: 2047-9956; 2047-9964
• DOI: 10.1136/ejhpharm-2020-eahpconf.201

Background and importanceChemotherapy dosing for obese patients (body mass index (BMI) ≥30 kg/m2) remains undefined. Most recent publications discourage arbitrary dose reductions that can compromise efficacy. However, because of the dose dependent cardiotoxicity of anthracyclines and also the inherent obesity related cardiovascular risk factors, it is advisable to review the evidence available on toxicity in this population.Aim and objectivesTo define the most adequate dose strategy for anthracyclines in obese adult patients based on efficacy and toxicity results and/or pharmacokinetic data.Material and methodsWe conducted a systematic review in Pubmed, Scopus and Web of Science using predefined keywords ((obese or obesity) and (daunorubicin or doxorubicin or epirubicin or idarubicin)). We excluded paediatric and non-English papers. Moreover, we looked at studies with relevant information about safety and efficacy.ResultsTen articles on doxorubicin, 4 on epirubicin, 2 on idarubicin and 1 on daunorubicin were included. Doxorubicin pharmacokinetics was evaluated in two articles: clearance was reduced and area under the curve was increased in obese patients but there were no statistically significant differences (SSD). Regarding efficacy, obese patients had better response ratios with no dose reduction with daunorubicin and idarubicin, but the difference was not significant. Epirubicin showed a better response when the full dose was used in neoadjuvant chemotherapy but there was no difference in progression free (PFS) or overall (OS) survival. One article reported worse pathological complete response, PFS and OS when the dose was reduced in obese breast cancer patients. Another article did not show SSD in recurrence risk and mortality when using a full dose, except if BMI ≥35 kg/m² when mortality was higher (p