ASCO2021发布关于肥胖成年癌症患者全身治疗剂量的新建议

2021-06-09 MedSci原创 MedSci原创

当用实际体重来确定剂量时,没有任何证据表明过量毒性,根据目前所知,该指南建议,没有证据支持限制剂量。

美国临床肿瘤学会(ASCO)批准了在肥胖成人癌症患者中适当剂量系统性抗癌药物的新建议。该指南的更新是基于对2010年11月1日至2020年3月27日发表的关于肥胖成人癌症化疗、免疫治疗和靶向治疗的文献的系统回顾收集的证据。2012年发布的最初指南仅关注化疗药物。该指南更新的动机是纳入有关剂量对肥胖癌症患者的影响、全体重剂量的益处以及任何有关非细胞毒性药物(如免疫治疗和靶向治疗)的证据的新数据。该指南缩小了自上次指南以来的部分差距,并更新了文献。

评估新药物的剂量建议

一直以来人们都担心化疗药物对超重或肥胖患者的潜在毒性。癌症治疗的剂量通常是基于病人的体表面积(病人的身高和体重的组合),所以病人越重,他们接受的药物量就越大。传统上,化疗剂量通常有一个上限,然而,研究表明,限制化疗剂量可能会导致肥胖患者剂量不足。

根据现有证据,2012年ASCO专家小组建议超重和肥胖患者接受实际计算剂量,而不考虑他们的体重。然而,从那时起,许多新的药物已经被批准用于癌症患者,包括酪氨酸激酶抑制剂,靶向单克隆抗体,以及最近的免疫疗法。所有这些疗法都与传统化疗截然不同,其中许多疗法的剂量与体重或体表面积没有那么密切的关系,因此,提供包括这些新疗法在内的更新是很重要的。

强化全体重剂量建议

这一最新的更新解决了成年肥胖癌症患者的6个临床问题,特别是:1.充分的、基于体重的细胞毒性化疗的安全性和有效性;2.使用固定剂量的细胞毒性化疗;3.已批准剂量的检查点抑制剂(固定剂量或基于体重的)的安全性和有效性;4.批准剂量的靶向治疗(固定剂量或基于体重的)的安全性和有效性;5.在高毒性的情况下,修改全身抗肿瘤治疗剂量或计划;6.计算体表面积的最好方法。

在对符合资格标准的60项研究的证据进行审查的基础上,专家小组建议如下:

1.化疗的全体重剂量,不论肥胖状况;2.美国食品和药物管理局(FDA)批准,仅对特定的细胞毒性药物使用固定剂量化疗;例如,博来霉素;3.在所有患者中使用FDA批准的免疫检查点抑制剂处方信息,无论是否肥胖;4.使用FDA批准的处方信息对所有患者进行靶向治疗,无论肥胖状况如何;5.根据已经确定的所有患者的减剂量指南,减少全身抗肿瘤治疗的剂量,无论患者是否肥胖;6.使用任何标准公式来计算体表面积。

关键的结论是,当用实际体重来确定剂量时,没有任何证据表明过量毒性,根据目前所知,该指南建议,没有证据支持限制剂量。在缺乏药代动力学和药效学数据的情况下,无法谈论额外的个性化。

离实现癌症治疗公平又近一步

些最新的建议将带来护理方面的改善,特别是在那些已经面临更大的次优结果风险的人群中。

最大的改善将是那些在实践中受到照顾的患者,他们继续关注最初的指南,现在正在更新指导方针,这应该会给肿瘤学家提供他们需要的支持。少数群体成员和其他边缘化的癌症患者更有可能拥有更高的体型,而整个体重剂量在他们的护理中更接近实现公平。

最初的2012年指南和2021年指南的更新都加强并建立了对超重或肥胖的成年癌症患者的系统治疗剂量的重要推荐护理ASCO专家小组建议这一患者群体应接受标准化和指南推荐的治疗,以减少不同实践环境中可能出现的不需要的、潜在有害的剂量差异。

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    2022-01-14 quxin068
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    2021-09-03 ms8000001330167946

    求全文

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    2021-06-09 ms4000001114161496

    肥胖患者

    0

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    2021-06-09 Kiki徐

    👍👍👍👍

    0