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Oncology pharmacists from around the globe met in Prague earlier this year to discuss progress and controversies relating to clinical and technical aspects of cancer treatment
Christine Clark
BSc MSc PhD FRPharmS FCPP(Hon)
Editor
HPE
Atotal of 589 participants from 51 countries worldwide attended the XII Symposium of the International Society of Oncology Pharmacy Practitioners held in Prague, Czech Republic, May 5–8, 2010. China, Chile and central African countries were represented at the symposium for the first time.
A survey of attendees showed that 75% of respondents were pleased or very pleased with the programme, the speakers and the venue. They identified the broad spectrum of topics, ranging from basics to high-level research and including practical and clinical aspects of oncology pharmacy, as being the most appealing feature of the ISOPP programme. Industrial participants also commented favourably on the venue and valued the opportunity to meet with opinion leaders in oncology pharmacy.
Automated preparation
In the 800-bed University Hospital in Ancona, Italy 90% of cytotoxic doses are now prepared by a robot. Dr Celestino Bufarini explained how two Apotecachemo® robots (Loccioni Humancare) have been installed and validated for the preparation of more than 45 different products, including products in infusion bags, syringes and elastomeric pumps. The robot utilises a six-axis anthropometric arm to manipulate the products. Driven by dedicated prescription management software the robot identifies the drugs and materials required, verifies the quantities needed and prepares individualised cytotoxic doses. The starting material can be a dry powder or a solution. Toxic waste is automatically packed into sealed containers for destruction.
The first robot was installed in 2007 and the project has progressed steadily since then. The proportion of cytotoxic doses prepared in the robots has progressively increased and the projected output for 2010 is 18,000 doses. Dr Bufarini concluded that robotic preparation of cytotoxics is feasible and has the advantage of reducing operator exposure to the drugs.
Renal function estimation
One of the talking points from one session of the symposium was the debate about the use of the modification of diet in renal disease (MDRD) equation to determine an estimated glomerular filtration rate (eGFR) as the basis for dose modification for anti-cancer treatments. Bruce Burnett (consultant pharmacist for cancer services, Glan Clwyd Hospital, Wales) explains, “The Food and Drug Administration (FDA) in the USA did allow the use of this method to determine drug dose amendments but this has recently changed. The formula can give misleading results in acutely unwell patients and, moreover, the data on older drugs were not derived using this calculation. The current British National Formulary recommends the use of eGFR to determine drug dose adjustments except for ‘toxic drugs’ with narrow therapeutic indices. The consensus in the session was that the Cockcroft and Gault equation rather than eGFR be used for all cytotoxic drugs and that the method of calculation should be validated for each drug.
Closed systems
The use of closed systems for preparation of cytotoxic doses also continues to be a matter of heated debate. There are now a number of connection devices but pharmacists are still concerned about the amount of contamination of the exterior surfaces of vials and ampoules when they leave the manufacturer. “In the UK we are fortunate – the majority of manufacturers now wash ampoules and vials at the final stage of manufacturing, but this is still not the case in all countries”, says Bruce. “However, we still have some way to go in ensuring that the process is closed from leaving the manufacturer to administration”, he adds.
The other potential advantage of a closed system connector is that it could make it easier to retain vials and use them for doses for more than one patient. “In the past this has been discouraged because it can involve removing the vial from the aseptic environment but if the integrity of the connector is validated then policies might be revisited and more economical use of products might be possible”, comments Bruce.
The next ISOPP Symposium will be held in 2012 in Melbourne, Australia.
