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Supportive Care in Cancer

, Volume 25, Issue 4, pp 1257–1261 | Cite as

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

  • Vincent Crosby
  • Catherine D’Souza
  • Carina Bristow
  • Amy Proffitt
  • Asmah Hussain
  • Vanessa Potter
  • Ivo Hennig
  • Richard O’Connor
  • Vickie Baracos
  • Andrew WilcockEmail author
Original Article

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.

Keywords

Chemotherapy Lean body mass Lung cancer Pharmacology Toxicity 

Notes

Acknowledgments

The study was funded by a Nottingham University Hospitals Charity pump-priming award. We want to thank the patients taking part and the colleagues who supported the study, particularly Rena Chauhan, Dr. Sally Morgan (Nottingham University Hospitals NHS Trust) and Professor Michael Randall (University of Nottingham).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Supplementary material

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Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Vincent Crosby
    • 1
  • Catherine D’Souza
    • 1
  • Carina Bristow
    • 1
  • Amy Proffitt
    • 1
  • Asmah Hussain
    • 1
  • Vanessa Potter
    • 2
  • Ivo Hennig
    • 2
  • Richard O’Connor
    • 3
  • Vickie Baracos
    • 4
  • Andrew Wilcock
    • 2
    Email author
  1. 1.Department of Palliative CareNottingham University Hospitals NHS TrustNottinghamUK
  2. 2.Department of Clinical OncologyNottingham University Hospitals NHS TrustNottinghamUK
  3. 3.Department of RadiologyNottingham University Hospitals NHS TrustNottinghamUK
  4. 4.Department of OncologyDivision of Palliative Care MedicineEdmontonCanada

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