Anticancer drug waste minimization and cost-saving study by using a closed-system transfer device for chemotherapy compounding.

INTRODUCTION: There is a need for an economic evaluation of the use of closed system (CSTD) in chemotherapy compounding, especially in resource-constrained settings. OBJECTIVE: The objective of this study was to assess the cost saving of the management of cancer drug leftovers before and after introduction of CSTD associated with an extension of the beyond-use date (BUD) of cancer vials. A secondary objective was to estimate the level of minimization of drug wastage. MATERIALS AND METHODS: This was a prospective, single-center study with two periods of two months each. The cost of drugs saved by using conventional systems (syringe and needle) without a closed system in the first period was compared to the cost of drugs saved by using the CSTD Chemoclave® system in the second period. The drug waste minimization rate compared actual drug waste to potential waste in Period 2. RESULTS: In Period 1, the amount of drug saved accounted for an average of 10.3% of the amount used in milligrams and the amount of drug wasted accounted for an average of 18.7%. In period 2, these proportions were 15.2% and 6.4% respectively. The CSTD generated an extra cost of 11,962.5 USD compared to the conventional system. The drug saved cost related only to the CSTD and the acquisition cost of the CSTD was a deficit of -7,444.95 USD and the cost saved from the compounding (CSTD and syringes) was a gain of 1,722.01 USD. The waste minimization represented an average of 72.5% ± 24.4% of potential waste. CONCLUSION: The use of CSTD to extend the BUD allowed to reduce waste due to microbiological instability without adding an economic profit.

Chemometric Analysis of UV-Visible Spectral Fingerprints for the Discrimination and Quantification of Clinical Anthracycline Drug Preparation Used in Oncology.

In clinical treatment, the analytical quality assessment of the delivery of chemotherapeutic preparations is required to guarantee the patient's safety regarding the dose and most importantly the appropriate anticancer drug. On its own, the development of rapid analytical methods allowing both qualitative and quantitative control of the formulation of prepared solutions could significantly enhance the hospital's workflow, reducing costs, and potentially providing optimal patient care. UV-visible spectroscopy is a nondestructive, fast, and economical technique for molecular characterization of samples. A discrimination and quantification study of three chemotherapeutic drugs doxorubicin, daunorubicin, and epirubicin was conducted, using clinically relevant concentration ranges prepared in 0.9% NaCl solutions. The application of the partial least square discriminant analysis PLS-DA method on the UV-visible spectral data shows a perfect discrimination of the three drugs with a sensitivity and specificity of 100%. The use of partial least square regression PLS shows high quantification performance of these molecules in solution represented by the low value of root mean square error of calibration (RMSEC) and root mean square error of cross validation (RMSCECV) on the one hand and the high value of R-square on the other hand. This study demonstrated the viability of UV-visible fingerprinting (routine approach) coupled with chemometric tools for the classification and quantification of chemotherapeutic drugs during clinical preparation.

Interactions between injectable anticancer drugs and polyvinyl chloride bags: Evaluation of the adsorption phenomenon after reconstitution.

INTRODUCTION: During the reconstitution of a drug and during its storage, there are risks of interactions between the drug and the bag used for the preparation. Polyvinyl chloride is a material used in the manufacture of a large part of chemotherapy infusion bags. It is subject to many interactions like sorption of drugs and release of phthalate additives. MATERIAL AND METHODS: Seven anticancer drugs used in pediatric oncology were involved in our study. After reconstitution of the anticancer agents in polyvinyl chloride bags, the adsorption phenomenon between the container and the contents is evaluated by infrared spectroscopy by analyzing the inner surface of the polyvinyl chloride. Subsequently, for the anticancer agents which exhibited an adsorption-container-content, the analysis was carried out by ultraviolet-visible spectrophotometry in order to examine the kinetics of the concentration of reconstituted anticancer drugs. RESULTS: All the polyvinyl chloride bags gave a spectrum identical to the spectrum of the reference bag, except the bags used to reconstitute etoposide whose spectra showed 12 additional peaks. With the absorbances measured by ultraviolet-visible spectrophotometry at different times, the analysis of variance statistical analysis shows that there is a significant difference in absorbances between t0 and all the other measurement times. CONCLUSION: This study testifies to the existence of a container-content interaction between etoposide and polyvinyl chloride. Thus, reconstitution of etoposide for intravenous infusion into a polyvinyl chloride bag should be used immediately. For etoposide preparations intended for storage beyond 24 h, it is recommended to use a container other than the polyvinyl chloride bag.

Evaluation of anti-infectives prescriptions in a pediatric hemato-oncological center: A retrospective study.

INTRODUCTION: A few years after the discovery and development of anti-infectives, this therapeutic feat gave way to bacterial resistance because of the overconsumption of antibiotics, most often with unjustified prescriptions. The objective was to evaluate the compliance of the prescription of antibiotherapy in the pediatric onco-hematology unit of Rabat Children's Hospital and to determine the drug interactions. MATERIAL AND METHODS: This is a retrospective study of anti-infectives prescriptions in pediatric onco-hematology. All prescriptions containing an antibiotic or antimycotic were isolated at the end of each month for analysis according to the ANSM standard. The variables of compliance analyzed in the prescriptions were: form, indication, posology, duration of the treatment, drug interactions and number of antibiotics which were prescribed. RESULTS: The prescriptions containing at least one anti-infective were 195. All the prescriptions were in conformity with their indications; 111 (57%) of the cases were conform with respect to all criteria; 20 (12%) prescriptions were not conform in their form, 12 (6.6%) contained at least one over-dosed drug and 52 (26.7%) contained at least one under-dosed drug. A drug interaction was found in 15 (7.7%) of cases, of which 12 (6.2%) are precautions for use. A drug interaction is present in 1(6,7%) cases when a single antibiotic is prescribed against 3 (20%) cases when 4 antibiotics are prescribed. (p = 0.007). CONCLUSION: The number of non-compliances in our study was high. It would therefore be advisable to recommend the establishment of an information system to minimize the non-compliances and to ensure a training program for young doctors on international recommendations.

Benzo[b]-1,8-naphthyridine derivatives: synthesis and reversal activity on multidrug resistance.

A series of benzo[b]-1,8-naphthyridine derivatives branched with various side-chains and substituents were prepared with the aim of being investigated as multidrug resistance (MDR) modulators. The syntheses were achieved from 2-halonicotinic acid and suitable aryl-amines according to a three-step procedure. All the derivatives were tested in vitro on mouse T-Lymphoma cell line L5178 transfected by MDR1 gene and the chemosensitizing properties of the compounds were compared to those of verapamil and propranolol, as well as to several other tricyclic derivatives like phenothiazines and acridines. Most of the compounds tested reversed the MDR of tumour cells more effectively than the reference drugs did and they showed more potent chemosensitizing activity than phenothiazine and acridine derivatives have.