Use of body weight and body surface area in dosing of anticancer agents in adult patients

Dosing of anticancer drugs in adults is mostly adjusted to estimated body surface area or body weight. Dose normalisation to body size is assumed to decrease the interindividual pharmacokinetic and pharmacodynamic variability. This approach is rarely validated before approval. Theoritically, body size should be used only if it has been demonstrated that it constitues a significant factor affecting clinical variability. Recent studies have shown, a posteriori, that several marketed anticancer agents could be administered at a fixed dose. Moreover, the abandon of body surface area in dosing of new drugs in phase I trials has been recommended. At the present time, body size continues to be used in the dosing of new agents in adult patients. This review presents the concepts and the limits of weight and body surface area-based dosing of anticancer drugs in adult patients.