Abstract
Several ovarian cancer studies suggested body mass index (BMI) ≥30kg/m2 is associated with lower compliance to National Comprehensive Cancer Network (NCCN) recommended chemotherapy, but primarily involved treatment before 2012 when dose-capping was recommended for patients with higher body surface area. Updated analyses in the contemporary treatment era are warranted.
In a retrospective cohort of patients newly diagnosed with ovarian cancer receiving curative intent carboplatin plus paclitaxel in the Yale-Smilow Cancer Network (2012-2022), we evaluated BMI at diagnosis in relation to relative dose intensity (RDI) - ratio of completed chemotherapy dose intensity to the NCCN recommended dose intensity-which reflects dose modification both before and during treatment. We additionally assessed starting RDI (reflects modifications before treatment) and received RDI (reflects modifications during treatment). Data on hospitalizations and hematologic chemotoxicities were also collected. We examined the association between BMI (<25, 25-30, ≥30kg/m2) and chemotherapy completion, hospitalizations, and toxicities using multivariable linear and logistic regressions.
Among 327 patients, average RDI was 79.7%, and 44.3% had a RDI < 85%. Mean starting and received RDI was 97.9 ± 9.1% and 81.8 ± 25.7%, respectively. Higher BMI was associated with higher RDI (paggregate=0.03) and received RDI (paggregate=0.04). BMI was not associated with starting RDI, dose reductions, delays, hospitalizations or hematologic toxicities.
Among patients with ovarian cancer treated since 2012, overall RDI was low. RDI was higher among patients with BMI ≥ 25 compared to BMI < 25. Most dose modifications occurred during treatment and not before initiation. Studies with body composition data and interventions that maximize chemotherapy completion during treatment are warranted.