Study on the Use of Ozone Water as a Chemical Decontamination Agent for Antineoplastic Drugs in Clinical Settings.

The exposure of healthcare workers to antineoplastic drugs in hospitals has been recognized to be harmful. To minimize the risk of exposure, the removal of these drugs from work environments, such as compounding facilities, has been recommended. In our previous paper, the degradation and inactivation efficacy of ozone water, which is being introduced into Japanese hospitals as a chemical decontamination agent, was reported for its effects on typical antineoplastic drugs (gemcitabine, irinotecan, paclitaxel). This article aims to further investigate the efficacy of ozone water for eight antineoplastic drugs to clarify its application limitations. A small amount (medicinal ingredient: typically ca. 1.5 µmol) of formulation containing 5-fluorouracil, pemetrexed, cisplatin, oxaliplatin, cyclophosphamide, ifosfamide, doxorubicin, or docetaxel was mixed with 50 mL of ozone water (~8 mg/L), and the resulting solutions were analyzed by high-performance liquid chromatography over time to observe the degradation. Consequently, the ozonation was overall effective for the degradation of the drugs, however this varied depending on the chemical structures of the drugs and additives in their formulations. In addition, after the parent drugs were completely degraded by the ozonation, the degradation mixtures were subjected to 1H nuclear magnetic resonance spectroscopy and evaluated for mutagenicity against Salmonella typhimurium strains and cytotoxicity against human cancer cells. The degradation mixtures of cisplatin and ifosfamide were mutagenic while those of the other drugs were non-mutagenic. Further, the ozonation resulted in clear decreases of cytotoxicity for 5-fluorouracil, oxaliplatin, and doxorubicin, but increases of cytotoxicity for pemetrexed, cisplatin, cyclophosphamide, and ifosfamide. These results suggest that the ozone water should be restrictedly used according to the situation of contamination in clinical settings because the ozonation enhances toxicity depending on the drug even if degradation is achieved.

Regimen of 5-Fluorouracil and Cisplatin Increases the Incidence of Extravasation in Patients Undergoing Chemotherapy.

BACKGROUND/AIM: Extravasation associated with chemotherapy can induce localised injury, necrosis, and nerve damage, resulting in discontinued chemotherapy and impaired quality of life; however, risk factors for extravasation remain unclear. The present study aimed to identify chemotherapy regimen-associated factors related to extravasation. PATIENTS AND METHODS: Data on patient and chemotherapy protocol characteristics were extracted from our hospital's electronic database; the frequency of extravasation was compared among patients receiving different chemotherapy regimens. RESULTS: Twenty-two patients with extravasation undergoing chemotherapy during the study period were enrolled in the present study. Patients undergoing treatment with 5-fluorouracil and cisplatin were most likely to develop extravasation in the present study. All patients presenting with extravasation during treatment with 5-fluorouracil and cisplatin developed swelling and many (40%) developed erythema within the first two cycles of treatment. CONCLUSION: Treatment with 5-fluorouracil combined with cisplatin increases the incidence of extravasation. Ensuring suitable vascular access and increasing awareness regarding the symptoms and timing of extravasation among patients and medical staff can improve extravasation prevention and diagnosis.