Effect of chemotherapy on resting energy expenditures in patients with non-Hodgkin's lymphoma: results of a sequential study

Article Abstract:

Changes in a patient's metabolism occur during chemotherapy, but little is known about these changes or what prognostic value they might have. Resting energy expenditure, which is just one aspect of metabolism, has been shown to decrease in patients with lung cancer only when the tumor has responded well to chemotherapy. It is not always possible to determine which aspects of a change are due to alterations in the tumor and which result from the effects of the chemotherapy on the body itself. For this reason, the resting energy expenditure was measured in 10 cancer patients during a total of three cycles of chemotherapy. It was thought that effects attributable to the tumor should be greatest during the fist cycle. The patients, who were diagnosed with non-Hodgkin's lymphoma, had three five-day cycles of intensive chemotherapy; resting energy expenditure was measured within two days of the start of chemotherapy and on days two, three, and five. During the first cycle, a significant reduction of energy expenditure was seen on days three and five, which might be attributable to metabolic effects on the tumor itself. During the second cycle, resting energy expenditure remained approximately constant throughout the cycle. However, during the third cycle the energy expenditures observed were significantly higher than that just prior to the start of the cycle. It should also be noted that throughout this study the patients maintained a positive energy balance, which may be due to a minimum of observed gastrointestinal side effects. Although the use of intravenous feeding has been advocated for patients with non-Hodgkin's lymphoma, the present study found no reason to suspect that this is necessary. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Research, Measurement, Energy metabolism, Non-Hodgkin's lymphomas, Chemotherapy

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Disposition of high-dose methotrexate in an obese cancer patient

Article Abstract:

Fatty tissues account for a higher proportion of total body weight among obese people. As a result, the distribution of therapeutic drugs in the bodies of obese patients is often significantly altered; this may result in decreased effectiveness of the drug or increased risks of toxic side effects. Unfortunately, many anticancer drugs have a narrow therapeutic index, that is, a narrow range of doses within which the drugs are effective but not overly toxic. The authors describe the treatment of an obese woman with osteosarcoma, a form of bone cancer. The standard adjuvant chemotherapy for osteosarcoma is the drug methotrexate, yet little is known about the disposition of this drug within the bodies of obese patients. The patient in this case was 184 percent of her ideal body weight (over 130 percent is considered to be severe obesity). Measurements of the amount of methotrexate in the patient's blood during chemotherapy indicated that a larger dose of methotrexate might be required to achieve the same blood levels observed in lean patients. The rate of clearance of the drug from the body was more rapid, however. About 90 percent of a dose of methotrexate is eliminated by the kidneys, and in the present case this increased clearance compensated for the greater effective volume in which the drug was distributed. The net result was that the time taken to eliminate the drug completely was essentially unchanged. The results suggest that kidney function may be a more important determinant of the effectiveness of methotrexate within the body than obesity. The authors suggest that kidney function should be monitored in obese patients receiving methotrexate, as should the blood levels of the drug. (Consumer Summary produced by Reliance Medical Information, Inc.)

Physiological aspects, Overweight persons, Obesity, Cancer patients, Methotrexate

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