Can body composition be used to optimize the dose of platinum chemotherapy in lung cancer? A feasibility study

Crosby, Vincent; D'Souza, Catherine; Bristow, Carina; Proffitt, Amy; Hussain, Asmah; Potter, Vanessa; Hennig, Ivo M.; O'Connor, Richard; Baracos, Vickie E.; Wilcock, Andrew

Abstract

Purpose Current methods of dosing platinum-based chemotherapy are suboptimal. Potentially, taking lean body mass into account may help. To inform the design of a future study, we first examined the feasibility and acceptability of such an approach using dual-energy X-ray absorptiometry (DEXA) and explored aspects suggestive of over- and under-dosing.
Methods Patients with lung cancer offered platinum-based chemotherapy over 1 year were identified and, if eligible, invited to take part in a prospective feasibility study. Questionnaires examined acceptability of the DEXA scan and of a future study that randomized between traditional dosing and one adjusted according to body composition. Dose-limiting toxicity (DLT) and a lack of neutropenia explored potential over- and under-dosing, respectively.
Results Of the 173 patients offered chemotherapy, 123 (71%) were ineligible, mostly because of failing entry criteria (84, 49%). Of the 50 approached, 18 (36%) participated, most receiving carboplatin, with 17 providing data. All found a DEXA scan acceptable; other assessments were fully completed, except nadir and pre-chemotherapy blood counts. Most (94%) were prepared to take part in a future study, although the additional hospital visits for a nadir blood count were unpopular with some. Five (29%) patients experienced six episodes of DLT which resulted in discontinuation (3), dose reduction (2) or change to a less toxic regimen (1). Nine (60%) patients experienced either no (2) or inconsistent (7) neutropenia.
Conclusions A randomized trial appears acceptable and feasible in patients receiving carboplatin. Adjustment of our entry criteria and avoiding a hospital visit for a nadir blood count should aid recruitment.

Citation

Crosby, V., D'Souza, C., Bristow, C., Proffitt, A., Hussain, A., Potter, V., Hennig, I. M., O'Connor, R., Baracos, V. E., & Wilcock, A. (in press). Can body composition be used to optimize the dose of platinum chemotherapy in lung cancer? A feasibility study. Supportive Care in Cancer, 25(4), https://doi.org/10.1007/s00520-016-3518-2

• Journal Article Type: Article
• Acceptance Date: Nov 28, 2016
• Online Publication Date: Dec 8, 2016
• Deposit Date: Nov 20, 2017
• Journal: Supportive Care in Cancer
• Print ISSN: 0941-4355
• Electronic ISSN: 1433-7339
• Publisher: Springer Verlag
• Peer Reviewed: Peer Reviewed
• Volume: 25
• Issue: 4
• DOI: https://doi.org/10.1007/s00520-016-3518-2
• Keywords: Chemotherapy, Lean body mass, Lung cancer, Pharmacology, Toxicity
• Public URL: https://nottingham-repository.worktribe.com/output/836006
• Publisher URL: https://link.springer.com/article/10.1007/s00520-016-3518-2
• Contract Date: Nov 20, 2017