Dose chemotherapy by muscle mass, not body surface area
Chemotherapy doses are calculated from height and weight, a formula from the 1950s. Doses based on actual muscle mass may cause fewer severe side-effects.
Body surface area poorly predicts clearance for most cytotoxics, and low lean body mass is associated with markedly higher rates of severe toxicity at standard doses, notably with fluoropyrimidines and taxanes. Lean mass is now measurable automatically from routine imaging, making an alternative dosing metric practical for the first time.
- Cachexia, toxicity and the limits of the patient · Patients often die of wasting or cannot tolerate the doses that would work. Treating the patient, not just the tumour, lags far behind.
- Wrong doses · Most drug doses were chosen as the highest a person can tolerate, which is often more than they need.
- Toxicity and quality of life are undervalued · Trials measure how long people live, not how they live. Side-effects are under-reported and under-treated.
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