[Examination of Actual Medical Material Cost and Cost Reduction Related to Exposure Prevention in the Preparation of Anticancer Drugs].

At Ogaki Municipal Hospital, we expanded the preparation of anticancer drugs using a closed system drug transfer device (CSTD)when revising medical fees in 2016. In this study, we investigated the number of regimens and number of preparations for outpatients in December 2017. Subsequently, the cost of all consumables related to the preparation of anticancer drugs was calculated. In total, 574 preparations of 68 regimens were conducted, with CSTD used in the preparation of 331 (57.7%)drugs. The cost associated with preparation of anticancer drugs was 1,608,163 yen/month, of which the CSTD cost was 1,135,315 yen/month(70.6%). Given the disproportionately high cost related to CSTD, we investigated for material cost reduction. Although CSTD has a mechanism for adjusting the differential pressure inside and outside the vial, the conditions were used to calculate medical fee; however, if we use what we do not have, we estimated that the facility burden would be reduced by 24.7%. CSTD can contribute not only to safety through exposure prevention but also to medical cost reduction through introduction of "Drug Vial Optimization." We believe it will continue to act as a medical evidence to reduce medical fee remuneration and ease the conditions of fee calculation.

The incidence and timing of leukocyte overshoot after pegfilgrastim administration.

INTRODUCTION: Pegfilgrastim is a PEGylated formulation of filgrastim with a long half-life. It is highly convenient and less burdensome for patients. However, white blood cell count may temporarily increase after administration; in particular, a leukocyte overshoot may be observed. The present study retrospectively examined the incidence and timing of leukocyte overshoot after pegfilgrastim administration. PATIENTS AND METHODS: Fifty-five patients (118 occasions of pegfilgrastim) were evaluated. Leukocyte overshoot was defined as white blood cell count ≥10,000/mm3 exceeding the reference value. RESULTS: Leukocyte overshoot was observed in 71.2% (84/118) occasions, in 76.4% (42/55) patients. The maximum white blood cell count ≥30,000/mm3 was observed in 30.5% (36/118) occasions in 45.5% (25/55) patients and was observed in 39.3% (33/84) occasions on day 1 after pegfilgrastim administration and 26.2% (22/84) on day 2. Leukocyte overshoot has been observed in only 23.1% (9/39) patients administered with normal granulocyte colony-stimulating factor. However, there were no patients with white blood cell counts ≥30,000/mm3. CONCLUSION: There was a higher frequency of occurrence of leukocyte overshoot in response to pegfilgrastim than in response to normal granulocyte colony-stimulating factor. High incidence of leukocyte overshoot was observed when blood was collected 1-2 days after administration of pegfilgrastim. It is important for patients to understand the characteristics of pegfilgrastim by conducting pharmaceutical guidance.

[Treatment Continuation and Safety of Eribulin for the Treatment of Metastatic Breast Cancer].

The purpose of treatment for patients with metastatic breast cancer is to maintain the patient's quality of life(QOL)with continued treatment for as long as possible.Eribulin was approved in April 2011 for the treatment of metastatic breast cancer, further increasing the selection of therapies available for the management of this disease.The current study presents a retrospective review of 31 patients who received eribulin in our hospital, and analyzes the factors related to the continuation and safety of its use.The median treatment continuation was 114 days(range, 8-281 days), and the treatment involved an average of 5 courses(range, 1-13 courses).There were no significant differences in the continuation of eribulin with regard to the number of previous chemotherapy regimens and modifications undergone by the patients.Neutropenia accounted for 80.6% of adverse eventsBGrade 3; however, the recovery was rapid.The rates of peripheral neuropathy and liver function failures were 12.9% and 6.5%, respectively. These results suggest that eribulin can be continued to be administered with the aim of maintaining QOL, and the therapy can be adjusted according to the patient's situation and the occurrence of adverse events by reducing the dose and treatment delays.

[Induction of allergic reactions by anticancer drugs in outpatient chemotherapy].

We must understand the conditions during the onset of allergic reactions induced by anticancer drugs in order to respond with an appropriate treatment. We have therefore conducted this study, focusing on allergic reactions induced by each anticancer drug used in outpatient chemotherapy. Allergic reactions occurred in a total of 3.9% (76 cases), most of which were induced by platinum and taxane anticancer drugs. The number of administrations at symptom onset and the times of onset for platinums and taxanes were 11. 7±1. 3 times and 43. 3±4. 8 minutes for platinum; and 2. 3±0. 5 times and 18. 1± 3. 6 minutes for taxanes, respectively. This demonstrated a significant difference between these two drugs(both were p< 0. 01). In terms of re-administration following the onset of allergic reactions, 21 cases(72. 4%)out of 29 cases(38. 2%) were able to continue the administration of suspected drugs. We studied various factors surrounding the possibility of continued administration to two groups which were or were not able to continue receiving treatment. No significant differences were observed between the groups. For continuous safe treatment, it is necessary to understand the characteristics of allergic reactions induced by each anticancer drug. It is also advisable to consider possible precautions(by introducing prevention regimens)and appropriate measures at the time of re-administration, following the onset of allergic reactions.

[Appearance of skin and nail toxicity in patients with breast cancer who underwent trastuzumab-containing chemotherapy].

Trastuzumab is used for patients with metastatic breast cancer of HER2 over expression and adjuvant chemotherapy. Trastuzumab is recognized as a medicine with few adverse effects, although infusion reaction at its first dosage appears in high frequency as a main adverse effect. However, because we realized that there were many patients who appeared to have skin toxicity or nail toxicity, the adverse effects of trastuzumab were investigated retrospectively. Of 51 cases who underwent trastuzumab-containing chemotherapy, 25 cases(49. 0%)had skin toxicity, 14 cases(27. 5%) had nail toxicity, and 12 cases(23. 5%)had both toxicities. Skin toxicity and nail toxicity appeared in 14 of 25 cases(56. 0%) and 6 of 14 cases(42. 9%)respectively, within 6 months after the first medication dosage. Symptoms of skin toxicity were eruptions on the face and body(14 cases; 27. 5%), skin detachment or thinning on hands and feet(9 cases; 17. 6%), itching (8 cases; 15. 7%), skin drying(7 cases; 13. 7%)and so on. On the other hand, symptoms of nail toxicity were softening, thinning, or loss(13 cases; 25. 5%), paronychia(4 cases; 7. 8%), and discoloration(2 cases; 3. 9%). Our present findings suggest that skin toxicity and nail toxicity are highly frequent adverse events for those taking trastuzumab, although the drug is considered to be a molecular target drug with few adverse effects.

[Clinical evaluation of calculating carboplatin doses using modification of diet in renal disease (MDRD) estimate and adverse events].

A modified diet in renal disease (MDRD), a formula to estimate glomerular filtration rate (GFR), was proposed by Levey in 2006. In this study, we compared the dosage of carboplatin (CBDCA) calculated using MDRD with that calculated by conservative creatinine clearance (Ccr), and investigated the actual dosage given and the incidence of its adverse effects. In the 101 patients undergoing chemotherapy including CBDCA, the dosage calculated from the estimated GFR was 16% lower than that based on the estimated Ccr. This difference was greater in those under 65 years, women and those with a body mass index (BMI) > or =25. The most prominent incidence of adverse effects was thrombocytopenia in patients with lung cancer. In men, a serum creatinine level of > or =0. 6 mg/dL, GFR of <50 mL/min/1. 73 m(2) and a combined use of gemcitabine were cited as the factors responsible for the development of thrombocytopenia. It was concluded that the MDRD formula is an effective tool for evaluating patients with impaired renal function. It was suggested, on the other hand, that the dosage for medication should be decided by giving due consideration to factors other than renal functions.

[Effects of pesticides on cytokines production by human peripheral blood mononuclear cells--fenitrothion and glyphosate].

In patients with pesticides poisoning, human immune system seems to be damaged. However, the effects of pesticides on human immune system, especially on cytokines production, have not been understood well. We investigated the effects of fenitrothion (MEP), an organophosphorus insecticide, and glyphosate (GLP), a phosphorus containing amino acid-type herbicide, on cytokines production by human peripheral blood mononuclear cells (PBMC). MEP inhibited the proliferative activity of PBMC at ranging from 1 to 500 microM in a concentration-dependent manner, whereas GLP had a slight inhibitory effect even at 1000 microM. The production of IFN-gamma and IL-2 was inhibited by MEP in a concentration-dependent manner, but GLP slightly inhibited their production only at 1000 microM. The production of TNF-alpha and IL-1 beta was not affected by MEP and GLP at the concentrations which significantly inhibited the proliferative activity and T cell-derived cytokine production. MEP inhibited the production of T cell-derived cytokine (IFN-gamma and IL-2), which indicates that MEP might have the potential of immunosuppressive action. On the other hand, GLP might be a pesticide with only a little damage to the immune system, according to the results in cytokines production. These results suggest that pesticides inhibit the immune system differently, and the grasp of immune condition might be useful for the prognostic presumption and the infectious danger of degree in patients with pesticides poisoning.