[Four Cases Who Experienced Extravasation of Anthracyclines and Had Dexrazoxane Therapy].

We analyzed 4 cases who experienced extravasation of anthracyclines and had dexrazoxane therapy in our hospital. Concerned drugs were 2 adriamycin and 2 amrubicin cases and all cases received steroid ointment therapy, and no cases showed severe condition such as skin ulcer. As dexrazoxane is known to enhance bone marrow suppression of anti-cancer drugs, the nadir of neutropenia and thrombocytopenia was observed from day 10 to 17 in our cases. We made a domestic manual and have used in various professionals. Dexrazoxane would contribute to the reduction of skin damage due to extravasation if we could manage bone marrow suppression successfully.

Evaluation for pharmacokinetic exposure of cytotoxic anticancer drugs in elderly patients receiving (R-)CHOP therapy.

(R-)miniCHOP therapy, which delivers approximately half-doses of the (R-)CHOP regimen, has shown efficacy and safety in patients who are more than 80 years old. This study aimed to compare the area under the plasma concentration-time curves (AUCs) of vincristine (VCR), doxorubicin (DXR), and cyclophosphamide (CPA) between (R-)CHOP and (R-)miniCHOP regimens. The AUCs were compared between patients aged 65-79 years receiving (R-)CHOP therapy and those aged 80 years and older receiving (R-)miniCHOP therapy. Age was not an independent variable for predicting the dose-adjusted AUCs (AUC/Ds) of cytotoxic anticancer drugs. The median AUCs of DXR and CPA were significantly smaller in the (R-)miniCHOP group than in the (R-)CHOP group (168.7 vs. 257.9 ng h/mL, P = 0.003, and 219.9 vs. 301.7 µg h/mL, P = 0.020, respectively). The median AUCs of VCR showed the same trend but the difference was not significant (24.83 vs. 34.85 ng h/mL, P = 0.135). It is possible that the AUCs of VCR, DXR, and CPA in patients aged 80 years and older receiving (R-)miniCHOP therapy may be lower than those in patients 65-79 years old receiving (R-)CHOP therapy.

[Availability evaluation of closed systems by using practical training kits for preparation of antitumor drugs].

The recent guidelines of the Japanese Society of Hospital Pharmacists on the antitumor drug preparation have recommended the use of closed systems such as the PhaSeal® system for preventing cytotoxicity in health care workers involved in the preparation of these drugs. The PhaSeal® system and Clave® Oncology system were evaluated using a practical training kit for the preparation of antitumor drugs. The two systems were compared in terms of handling time, satisfaction as to availability, leakage of drugs from the connections in the system and area of drug spillage because improvements in convenience or lower cost system were available. With the closed systems, the average handling time increased by 10∼20%. The area of drug spillage did not significantly decrease. Leakage of drugs from the system was detected for all samples prepared with the Clave® Oncology system, and for some samples prepared with the PhaSeal® system. In terms of availability, the PhaSeal® system was better than the Clave® Oncology system. In conclusion, to decrease the exposure of health care workers to antitumor drugs during their preparation in a closed system, it is important to evaluate the handling time, operability, robustness with regard to drug leakage and spillage, and proficiency in handling of the closed system.

[Survey on the compliance of patients with continuous infusion of 5-fluorouracil via portable infusion pumps].

A portable infusion pump is essential to sustain the 46-hour continuous administration of 5-fluorouracil in the folinic acid, fluorouracil, and oxaliplatin (FOLFOX) and folinic acid, fluorouracil, and irinotecan (FOLFIRI) protocols in colorectal cancer chemotherapy. However,the accuracy of the 5-fluorouracil dose administered via the infusion pump and patient compliance varies because the infusion rate changes depending on the viscosity of the drug, temperature, etc. In addition, the termination of administration based on the patient's judgment may influence these factors. In the present study, the amount of 5-fluorouracil remaining in the infusion pump and the administration time were investigated. As a result, the median amount that was found to remain in the pump was 49 mg, which was 2.0% of the average dosage, and an median administration time delay of 70 min was obtained. A questionnaire survey revealed that a majority of the patients felt insecurity about in adequate administration and administration time delays. These results indicate that customizing capacity modulation in the infusion pump corresponding to the patient's usage or seasonal variability of air temperature, and patient education may be important to improve patient compliance.

[Effect of preliminary medication on oxaliplatin hypersensitivity].

Oxaliplatin therapy is a standard treatment for advanced colorectal cancer, and oxaliplatin hypersensitivity is one of its side effects that should be particularly considered. In the present study, we observed a decrease in the incidence of oxaliplatin hypersensitivity since the introduction of preliminary medication involving the administration of escalated doses of steroids and the use of antihistamine agents. From the medical economics perspective, although the costs of the preliminary medication were generated, those for the treatment of oxaliplatin hypersensitivity, which were higher than the total cost of the preliminary medication, needed to be generated for all patients. Introduction of preliminary medication decreased the overall cost, since the medication decreased the incidence of hypersensitivity. Therefore, preliminary medication was recognized to be effective from the perspective of medical economics. The preliminary medication we introduced contributed to a safe, cost-effective, and high-quality treatment for advanced colorectal cancer by preventing oxaliplatin hypersensitivity.

[Change in patient satisfaction in outpatient chemotherapy unit--comparison in 2005 and 2008].

We investigated the influences of the treatment environment, in terms of the increased number of treatments, introduction of regimen assessment and registration system, and the levels of specialization of the concerned medical professionals on patient satisfaction. We compared our results with those of a previous survey conducted in the outpatient chemotherapy unit of Hirosaki University Hospital. The patients were satisfied with respect to the privacy considerations and waiting time. However, a decrease in the patient instruction time led to slightly lower patient satisfaction. We concluded that it is useful to evaluate the quality of treatment in terms of patient satisfaction in a hospital.

Antiproteinuric effects of renin-angiotensin inhibitors in lung cancer patients receiving bevacizumab.

PURPOSE: The objective of this study was to investigate the effect of renin-angiotensin system inhibitors (RASIs) on bevacizumab (BV)-induced proteinuria in non-small cell lung cancer (NSCLC) patients. MATERIALS AND METHODS: We retrospectively reviewed the medical records of NSCLC patients receiving BV between 2008 and 2014 at 11 hospitals. The patients were categorized into three groups according to their antihypertensive drug use: RASI user, non-RASI user, and non-user groups. The primary outcome was a proteinuria event of any grade during the first 6 cycles of BV treatment. RESULTS: A total of 211 patients were included, 89 of whom received antihypertensive drugs. Of these 89 patients, 49 were in the RASI user group, and 40 were in the non-RASI user group. The non-user group comprised 122 patients. The occurrence of proteinuria in the RASI user group was significantly lower than that in the non-RASI user group (P = 0.037) but was not significantly lower than that in the non-user group (P = 0.287). Patients using RASIs had a lower rate of proteinuria than those who did not use RASIs according to multivariate analysis (odds ratio 0.32; 95% confidence interval 0.12-0.86; P = 0.024). CONCLUSION: Our study suggests that RASI administration reduces the risk of proteinuria in patients receiving BV.

[Survey on antiemetic therapy in ambulatory cancer chemotherapy and medical economics for standardization].

A cancer chemotherapy unit was established to support therapy for outpatients with cancer in Hirosaki University Hospital. It is essential to standardize antiemetic therapy, since a wide variety of the therapy provided to the unit from the diagnosis and treatment departments were conventional and empirical. We surveyed the use conditions and compatibility of the therapy based on reliable guidelines, and then considered the medical economics for standardization. In moderate-grade emetogenic chemotherapy, 5-HT(3) receptor antagonists tended to be used frequently instead of the recommended steroids. From this survey, the standardization of the cost of 5-HT(3) receptor antagonists and the relatively inexpensive steroids used in cancer chemotherapy might reduce either the nausea or vomiting suffered by patients with cancer and their economic burden as well.