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- Title
The association between BMI and BSA–temozolomide-induced myelosuppression toxicities: a correlative analysis of NRG oncology RTOG 0525.
- Authors
Robins, H Ian; Eickhoff, Jens; Gilbert, Mark R; Armstrong, Terri S; Shi, Wenyin; Groot, John F De; Schultz, Christopher J; Hunter, Grant K; Valeinis, Egils; Roach, Mack; Youssef, Emad F; Souhami, Luis; Howard, Steve P; Lieberman, Frank S; Herman, James G; Zhang, Peixin; Mehta, Minesh P
- Abstract
Background Fearing increased myelotoxicity, many practitioners adjust the body surface area (BSA)-calculated doses in obese patients. Regarding temozolomide (TMZ), a prior study suggested men with a BSA >2 m2 may experience increased toxicity; however, surprisingly, the inverse observation was noted in women, ie, BSA <2 m2 was associated with higher toxicity. To further clarify this issue, data derived from a large clinical trial were analyzed. Methods The incidence of grade 3 and 4 myelotoxicity in a newly diagnosed glioblastoma phase 3 trial (RTOG 0525) was statistically correlated with BMI and separately with BSA. All patients received radiation and TMZ followed by adjuvant standard dose TMZ vs dose-dense TMZ; dosing regimen-associated myelotoxicity and BMI/BSA were analyzed separately. Obesity was defined as a BMI ≥30. Results There was no statistically significant correlation between gender and BSA and the occurrence of myotoxicities. For the standard arm, surprisingly the incidence of grade 3/4 myotoxicities in patients with a BMI <30 was significantly higher than in patients with a BMI ≥30 (12% vs 1%, odds ratio [OR] 12.5, P <.001). There was no significant difference between obese and nonobese patients (BMI "cut-point" of 30) in the dose-dense arm (OR = 0.9, 95% confidence interval: 0.4–1.6). The grade hematological 3/4 toxicity rate was significantly higher in women vs men (14% vs 8%) P =.009 in spite of the lack of association between gender and BSA or BMI. Conclusion TMZ dosing based on actual BSA is recommended with the caveat that woman are likely at higher toxicity risk.
- Subjects
BODY surface area; MYELOSUPPRESSION; OLIGODENDROGLIOMAS; ODDS ratio
- Publication
Neuro-Oncology Practice, 2019, Vol 6, Issue 6, p473
- ISSN
2054-2577
- Publication type
Article
- DOI
10.1093/nop/npz006