Are there concerns in use or dosing of immunotherapy agents in extreme obesity?
Do you have a BMI threshold where you would convert to weight-based dosing over flat dosing? Are certain agents of more or less concern - PD-1, PD-L1, CTLA4 inhibitors?
Answer from: Medical Oncologist at Academic Institution
I do not have a threshold for dosing based on BMI. Flat dosing is now typically used for single agent immunotherapeutic agents such as durvalumab. We still do not know the optimal dosing, schedule, or duration of therapy defining the use of immunotherapy in general. There are reports that obesity is...
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Answer from: Medical Oncologist at Academic Institution
This is a provocative question for many reasons. From a biologic point of view, the effect on obesity and the host immune system are an area of active studies. Some retrospective/preclinical studies suggest worse outcomes for obese patients treated with anti-PD1 therapy (Boi et al., PMID 33427691) w...
Answer from: Medical Oncologist at Academic Institution
No, we do not have a BMI threshold at our institution. PD-1, PD-L1 are continued as flat doses; occasionally CTLA4 inhibitors might be dosed as weight based, using adjusted weight for patients with BMI >30.
Kinjal (Shah) Patel, Pharm D., BCOPClinical Pharmacy SpecialistFox Chase Cancer Center