Chemotherapy dose reduction is associated with worse survival in ovarian cancer, according to a study published in JAMA Oncology.

Elisa V. Bandera, M.D., Ph.D., from the Rutgers Cancer Institute of New Jersey in New Brunswick, and colleagues examined the impact of body mass index (BMI) on chemotherapy dosing and dose reduction on ovarian cancer survival. Data were included for 806 patients with primary invasive epithelial ovarian cancers.

The researchers found that a high BMI was the strongest predictor of dose reduction, with 38 and 45 percent lower doses in mg/kg of body weight of paclitaxel and carboplatin, respectively, for obese class III versus normal-weight women (both P < 0.001).

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For each agent and combined regimen, obese women received lower relative dose intensity (RDI), calculated as average RDI (ARDI).

The mean ARDI was 73.7 and 88.2 percent for obese class III and normal-weight women, respectively (P < 0.001). There were significant correlations for lower ARDI (<70 percent) with worse overall and ovarian cancer-specific survival (hazard ratios, 1.62 and 1.69, respectively).

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Worse survival was seen for normal-weight women with dose reduction (ARDI <85 percent), compared with normal-weight women with no dose reduction (hazard ratio, 1.50). Those with ARDI <85 percent had worse survival across BMI categories.

“Our results suggest that body size should not be a major factor influencing dose reduction decisions in women with ovarian cancer,” the authors write.


  1. Bandera, Elisa V., MD, PhD, et al. “Impact of Chemotherapy Dosing on Ovarian Cancer Survival According to Body Mass Index.” JAMA Oncology. doi:10.1001/jamaoncol.2015.1796. [epub ahead of print]. July 2, 2015.