Reply to the letter to the editor ‘Higher rate of severe toxicities in obese patients receiving dose-dense (dd) chemotherapy according to unadjusted body surface area: results of the prospectively randomized GAIN study’ by Daly et al.

In the letter related to our work [1], Daly et al. underline the association between body composition and increased treatment toxicity, suggesting to use the lean body mass (LBM) instead of body mass index (BSA) to improve the individualization of cytotoxic drugs doses. We agree that the use of BSA is far from being the most accurate way to define chemotherapy doses in normal weight as well as in obese patients, as it does not reflect pharmacokinetic parameters. Despite all the criticism arising around the BSA formula, it is the only standardized method available, until today. Therefore, all efforts should be made to improve its use as long as no other validated method is available. ASCO guidelines recommend using full weight-based chemotherapy to treat obese patients with cancer, particularly when cure is the main goal [2]. Despite that, we demonstrated that a dose adjustment of intense dose-dense chemotherapy should be carried out to avoid life-threatening complications in obese patients with early breast cancer (EBC) [3].

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