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Link to original content: https://pubmed.ncbi.nlm.nih.gov/11953888
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Case Reports
. 2002 Apr 22;86(8):1297-302.
doi: 10.1038/sj.bjc.6600139.

How to calculate the dose of chemotherapy

Howard Gurney  1
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Free PMC article
Case Reports

How to calculate the dose of chemotherapy

Howard Gurney. Br J Cancer. .
Free PMC article

Abstract

Body surface area-dosing does not account for the complex processes of cytotoxic drug elimination. This leads to an unpredictable variation in effect. Overdosing is easily recognised but it is possible that unrecognised underdosing is more common and may occur in 30% or more of patients receiving standard regimen. Those patients who are inadvertently underdosed are at risk of a significantly reduced anticancer effect. Using published data, it can be calculated that there is an almost 20% relative reduction in survival for women receiving adjuvant chemotherapy for breast cancer as a result of unrecognised underdosing. Similarly, the cure rate of cisplatin-based chemotherapy for advanced testicular cancer may be reduced by as much as 10%. The inaccuracy of body surface area-dosing is more than an inconvenience and it is important that methods for more accurate dose calculation are determined, based on the known drug elimination processes for cytotoxic chemotherapy. Twelve rules for dose calculation of chemotherapy are given that can be used as a guideline until better dose-calculation methods become available. Consideration should be given to using fixed dose guidelines independent of body surface area and based on drug elimination capability, both as a starting dose and for dose adjustment, which may have accuracy, safety and financial advantages.

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Figure 1
Figure 1
Hypothetical phase I study of a drug with linear pharmacokinetics. Horizontal bars represent interpatient variation in systemic exposure. Each vertical tick mark represents an individual patient on the study. Dose level 3 would be considered the MTD and dose level 2 would be recommended for phase II study despite the majority of patients on that dose level having a systemic exposure in the sub-therapeutic range.
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