Obesity and Dose of Anti-cancer Therapy: Are We Sure to Be on the Right Track in the Precision Medicine Era?

Abstract

Obesity, defined in adults by a body mass index (BMI) greater than or equal to 30 kg/m2 is a growing public health issue, affecting mainly Western countries. In the past, adipose tissue was considered as an inert component with a mere lipid storage function but to date it is recognized as a real organ with metabolic functions. Its relation with increased cancer risk and influence on anti-cancer therapy is not new, especially in association with the low-grade inflammation that characterizes adiposity (1–3). Therefore, adipose tissue cannot be ignored when anti-cancer therapy dosage is calculated. The only current method for cancer therapy dose calculation considers body surface area (BSA), which is not a surrogate of obesity and doesn't take into account any inter-individual variable, resulting in floating effects. Integration of BMI has demonstrated to reduce chemotherapy-induced toxicity, but the formula remains not exhaustive (4). Here, we criticize the use of BSA and BMI for cancer-therapy dose adjustment, highlighting the need to develop a comprehensive algorithm that could dramatically improve the personalized medicine concept in oncology.