Anticancer drugs in surface waters: what can we say about the occurrence and environmental significance of cytotoxic, cytostatic and endocrine therapy drugs?

This study considers the implications and research needs arising from anticancer (also referred to as antineoplastic) drugs being released into the aquatic environment, for the entire therapeutic classes used: cytotoxic, cytostatic and endocrine therapy drugs. A categorization approach, based on French consumption amounts, allowed to highlight parent molecules and several metabolites on which further occurrence and ecotoxicological studies should be conducted. Investigations of consumption trends at a national and a local scale show an increase in the use of anticancer drugs between 2004 and 2008, thus leading to increased levels released in the environment.

Chemotherapy for metastatic breast cancer. Comparison of clinical practice and cost of drugs in two cohorts of patients: 1994-1998 and 2003-2006.

Although new chemotherapeutic drugs for metastatic breast cancer (MBC) have been approved over the past decade, it is unclear whether this has changed the overall outcome of patients. This study assessed the clinical and economic impacts of these drugs. We retrospectively studied MBC patients receiving chemotherapy in our institution over two time periods, 1994-1998 and 2003-2006.

[Continuous training program for technicians handling antineoplastic drugs and occupational exposure risk].

Training and regular evaluation of technicians involved in the preparation of antineoplastic agents seems essential to reduce occupational exposure. In this way, a continuous training program was established. Technicians were asked to prepare a safe simulated liquid cytotoxic drug with a fluorescein solution (10 mg/L).

Contamination of syringe plungers during the sampling of cyclophosphamide solutions.

The presence of cytotoxic agents in the urine of operators and in their environment has been demonstrated. The pharmacokinetics of the urinary elimination of cyclophosphamide suggests that these drugs are absorbed cutaneously during handling. In the framework of a more general study on the contamination of hospital environment, the present study addresses the possible presence of cytotoxic agents on the plungers of syringes.

[Analysis of cyclophosphamide in the urine of antineoplastic drugs handlers].

The first study in which amounts of cyclophosphamide were found in the urine of nurses handling cytotoxic drugs using gas chromatography was published in 1984. We carried out a similar investigation on six pharmacy technicians involved in the preparation of antineoplastic agents (25,000 doses per year) but the analysis was performed with a more sensitive method: gas chromatography-mass spectrometry (LOQ = 0.1 ng/ml).