Body-surface-area dosing

Donald Pinkel proposed in 1958 that anticancer drug doses be scaled to body surface area, because clearance across species tracked surface area better than weight, and the convention spread to adults. Surface area is estimated from height and weight by the Du Bois or Mosteller formulas. Pharmacokinetic studies later showed that surface area explains little of the variation in clearance between adults, that dose capping in obese patients underdoses them, and that many antibodies and oral targeted drugs are as well given at flat doses. Body-surface-area dosing persists for classic cytotoxics, while carboplatin is dosed by kidney function and children's doses use weight or surface area by age.