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Febvey-Combes O, Guitton J, Marec-Berard P, Faure-Conter C, Blanc E, Chabaud S, Conjard-Duplany A, Schell M, Derain Dubourg L. Renal toxicity of ifosfamide in children with cancer: an exploratory study integrating aldehyde dehydrogenase enzymatic activity data and a wide-array urinary metabolomics approach. BMC Pediatr 2024; 24:196. [PMID: 38504218 PMCID: PMC10949630 DOI: 10.1186/s12887-024-04633-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 02/08/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND Ifosfamide is a major anti-cancer drug in children with well-known renal toxicity. Understanding the mechanisms underlying this toxicity could help identify children at increased risk of toxicity. METHODS The IFOS01 study included children undergoing ifosfamide-based chemotherapy for Ewing sarcoma or rhabdomyosarcoma. A fully evaluation of renal function was performed during and after chemotherapy. Proton nuclear magnetic resonance (NMR) and conventional biochemistry were used to detect early signs of ifosfamide-induced tubulopathy. The enzymatic activity of aldehyde dehydrogenase (ALDH) was measured in the peripheral blood lymphocytes as a marker of ifosfamide-derived chloroacetaldehyde detoxification capacity. Plasma and urine concentrations of ifosfamide and dechloroethylated metabolites were quantified. RESULTS The 15 participants received a median total ifosfamide dose of 59 g/m2 (range: 24-102), given over a median of 7 cycles (range: 4-14). All children had acute proximal tubular toxicity during chemotherapy that was reversible post-cycle, seen with both conventional assays and NMR. After a median follow-up of 31 months, 8/13 children presented overall chronic toxicity among which 7 had decreased glomerular filtration rate. ALDH enzymatic activity showed high inter- and intra-individual variations across cycles, though overall activity looked lower in children who subsequently developed chronic nephrotoxicity. Concentrations of ifosfamide and metabolites were similar in all children. CONCLUSIONS Acute renal toxicity was frequent during chemotherapy and did not allow identification of children at risk for long-term toxicity. A role of ALDH in late renal dysfunction is possible so further exploration of its enzymatic activity and polymorphism should be encouraged to improve the understanding of ifosfamide-induced nephrotoxicity.
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Affiliation(s)
- Olivia Febvey-Combes
- Centre Léon Bérard, Direction de la Recherche Clinique et de l'Innovation, Lyon, France
| | - Jérôme Guitton
- Laboratoire de Pharmacologie et Toxicologie, Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre-Bénite, France
- Faculté de Pharmacie, Département de toxicologie, Université Claude Bernard Lyon 1, Lyon, France
| | - Perrine Marec-Berard
- Institut d'hématologie et d'oncologie pédiatrique - Centre Léon Bérard, Département d'oncologie pédiatrique, Lyon, France
| | - Cécile Faure-Conter
- Institut d'hématologie et d'oncologie pédiatrique - Centre Léon Bérard, Département d'oncologie pédiatrique, Lyon, France
| | - Ellen Blanc
- Centre Léon Bérard, Direction de la Recherche Clinique et de l'Innovation, Lyon, France
| | - Sylvie Chabaud
- Centre Léon Bérard, Direction de la Recherche Clinique et de l'Innovation, Lyon, France
| | - Agnès Conjard-Duplany
- Faculté de Médecine Lyon Est, Physiopathologie et Génétique du Neurone et du Muscle, Université Lyon1, CNRS UMR 5261, INSERM U1315, Lyon, France
| | - Matthias Schell
- Institut d'hématologie et d'oncologie pédiatrique - Centre Léon Bérard, Département d'oncologie pédiatrique, Lyon, France
| | - Laurence Derain Dubourg
- Service de Néphrologie, Hospices Civils de Lyon, Hôpital Edouard Herriot, Dialyse, Hypertension et Exploration Fonctionnelle Rénale 5, place d'Arsonval, Lyon cedex 03, 69437, France.
- Université Lyon 1, CNRS UMR 5305, Lyon, France.
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P S S, Trivedi RK, Srinivas NR, Mullangi R. A review of bioanalytical methods for chronic lymphocytic leukemia drugs and metabolites in biological matrices. Biomed Chromatogr 2019; 34:e4742. [PMID: 31749152 DOI: 10.1002/bmc.4742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 10/24/2019] [Accepted: 10/30/2019] [Indexed: 12/31/2022]
Abstract
Quantitation of drugs used for the treatment of chronic lymphocytic leukemia in various biological matrices during both pre-clinical and clinical developments is very important, often in routine therapeutic drug monitoring. The first developed methods for quantitation were traditionally done on LC in combination with either UV or fluorescence detection. However, the emergence of LC with mass spectrometry in tandem in early 1990s has revolutionized the quantitation as it has provided better sensitivity and selectivity within a shorter run time; therefore it has become the choice of method for the analysis of various drugs. In this article, an overview of various bioanalytical methods (HPLC or LC-MS/MS) for the quantification of drugs for the treatment of chronic lymphocytic leukemia, along with applicability of these methods, is given.
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Affiliation(s)
- Suresh P S
- Jubilant Biosys, 2nd Stage, Bangalore, India
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3
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Shu P, Zhao T, Wen B, Mendelsohn-Victor K, Sun D, Friese CR, Pai MP. Application of an innovative high-throughput liquid chromatography-tandem mass spectrometry method for simultaneous analysis of 18 hazardous drugs to rule out accidental acute chemotherapy exposures in health care workers. J Oncol Pharm Pract 2019; 26:794-802. [PMID: 31483750 DOI: 10.1177/1078155219870591] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVES Despite safe handling guidelines published by several groups, health care worker exposure to hazardous drugs continues to occur due to suboptimal engineering controls and low use of protective equipment. Simple, multi-target and specific analytical methods are needed so that acute exposures to these drugs in the workplace can be assessed rapidly. Our aim was to develop an analytical method for simultaneous detection and quantification of widely used cancer drugs to rule out accidental acute chemotherapy exposures in health care workers. METHODS We examined the feasibility of alternate high-performance liquid chromatographic-tandem mass spectrometry methods to simultaneously detect eighteen chemotherapy analytes in plasma and urine. The linear concentration ranges tested during assay development were 0.1-50 ng/mL. After development of a multi-analyte assay protocol, plasma samples (n = 743) from a multi-center cluster-randomized clinical trial (n = 12 sites) of an hazardous drug educational intervention were assayed. Confirmatory assays were performed based on the individual acute-spill case-histories. RESULTS An innovative HPLC-multiple reaction monitoring-information dependent acquisition-enhanced production ion (MRM-IDA-EPI) analytical method was developed to simultaneously detect: cytarabine, gemcitabine, dacarbazine, methotrexate, topotecan, mitomycin, pemetrexed, irinotecan, doxorubicin, vincristine, vinblastine, ifosamide, cyclophosphamide, vinorelbine, bendamustine, etoposide, docetaxel, and paclitaxel. The retention times ranged from 4 min to 13 min for the analytical run. The limit of detection (MRM-IDA-EPI) and limit of quantitation (MRM) was 0.25 ng/mL and 0.1 ng/mL, respectively for most analytes. No detectable plasma concentrations were measured at baseline, post-intervention and in cases of documented acute spills. Use of a secondary tandem mass spectrometry approach was able to successfully rule out false positive results. CONCLUSIONS Development of a sensitive high-throughput multi-analyte cancer chemotherapy assay is feasible using an MRM-IDA-EPI method. This method can be used to rapidly rule out systemic exposure to accidental acute chemotherapy spills in health care workers.
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Affiliation(s)
- Pan Shu
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Michigan, Ann Arbor, MI, USA
| | - Ting Zhao
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Michigan, Ann Arbor, MI, USA
| | - Bo Wen
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Michigan, Ann Arbor, MI, USA
| | | | - Duxin Sun
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Michigan, Ann Arbor, MI, USA
| | | | - Manjunath P Pai
- Department of Clinical Pharmacy, College of Pharmacy, University of Michigan, Ann Arbor, MI, USA
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A review of high performance liquid chromatographic-mass spectrometric urinary methods for anticancer drug exposure of health care workers. J Chromatogr B Analyt Technol Biomed Life Sci 2017; 1060:316-324. [PMID: 28654869 DOI: 10.1016/j.jchromb.2017.06.028] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 06/14/2017] [Accepted: 06/17/2017] [Indexed: 12/15/2022]
Abstract
This review describes published high performance liquid chromatography/mass spectrometry (HPLC-MS) methods for the determination of anticancer drugs in human urine as non-invasive tool for monitoring of health care worker exposure to antineoplastic and cytotoxic drugs. HPLC-MS is a sensitive and specific method for analysis of anticancer drugs and their metabolites in biological fluids. In this review, a tabular summary and overview of published HPLC-MS methods are presented, as well as future trends and limitations in this area of research.
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Guichard N, Guillarme D, Bonnabry P, Fleury-Souverain S. Antineoplastic drugs and their analysis: a state of the art review. Analyst 2017; 142:2273-2321. [DOI: 10.1039/c7an00367f] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
We provide an overview of the analytical methods available for the quantification of antineoplastic drugs in pharmaceutical formulations, biological and environmental samples.
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Affiliation(s)
- Nicolas Guichard
- Pharmacy
- Geneva University Hospitals (HUG)
- Geneva
- Switzerland
- School of Pharmaceutical Sciences
| | - Davy Guillarme
- School of Pharmaceutical Sciences
- University of Geneva
- University of Lausanne
- Geneva
- Switzerland
| | - Pascal Bonnabry
- Pharmacy
- Geneva University Hospitals (HUG)
- Geneva
- Switzerland
- School of Pharmaceutical Sciences
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Canal-Raffin M, Khennoufa K, Martinez B, Goujon Y, Folch C, Ducint D, Titier K, Brochard P, Verdun-Esquer C, Molimard M. Highly sensitive LC-MS/MS methods for urinary biological monitoring of occupational exposure to cyclophosphamide, ifosfamide, and methotrexate antineoplastic drugs and routine application. J Chromatogr B Analyt Technol Biomed Life Sci 2016; 1038:S1570-0232(16)31088-1. [PMID: 28029545 DOI: 10.1016/j.jchromb.2016.10.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 10/17/2016] [Accepted: 10/19/2016] [Indexed: 10/20/2022]
Abstract
Highly sensitive ESI-LC-MS/MS methods were developed for urinary biological monitoring of occupational exposure to cyclophosphamide (CP), ifosfamide (IF), and methotrexate (MTX), which are hazardous antineoplastic drugs frequently handled by healthcare professionals. Extraction methods consisted of liquid/liquid extraction for simultaneous urinary CP and IF assays, and of solid phase extraction for the urinary MTX assay. A good linearity (r2>0.997), precision (CV<14.6%), and accuracy (bias<9.9%) were achieved for all compounds. The limit of detection (LOD) was 10pg/ml and the lower limit of quantification (LOQ) was 20pg/ml for all three drugs. Applying these methods in routine, more than 116 healthcare professionals occupationally exposed to antineoplastic drugs were monitored and 635 urines were analysed. Eleven healthcare professionals (9.5%) were found to be contaminated to at least one of the three antineoplastic drugs. Among analysed urines, 22 samples were found positives. The measured concentrations ranged from 20.1 to 1850pg/ml and, for six samples, concentrations were at CP trace level, between the LOD and LOQ values (10-20pg/ml). Such efficient analytical tools combining high specificity with high sensitivity are essential for reliable detection and routine biological monitoring of healthcare professionals occupationally exposed to these widely used antineoplastic drugs. These methods allow to monitor the healthcare professionals exposure to antineoplastic drugs in the aim to assess the effectiveness of collective and individual protective measures.
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Affiliation(s)
- Mireille Canal-Raffin
- Laboratoire de Pharmacologie Clinique et Toxicologie, CHU de Bordeaux, 33076 Bordeaux, France; INSERM U1219, ISPED, Université de Bordeaux, 33076 Bordeaux, France; Service de Médecine du Travail et de Pathologies Professionnelles, CHU de Bordeaux, 33076 Bordeaux, France; Univ. of Bordeaux, 33076 Bordeaux, France.
| | - Karim Khennoufa
- Laboratoire de Pharmacologie Clinique et Toxicologie, CHU de Bordeaux, 33076 Bordeaux, France
| | - Béatrice Martinez
- INSERM U1219, ISPED, Université de Bordeaux, 33076 Bordeaux, France; Univ. of Bordeaux, 33076 Bordeaux, France
| | - Yves Goujon
- Association d'Hygiène Industrielle Bordeaux (AHI33), 33070 Bordeaux, France
| | - Celia Folch
- Service de Médecine du Travail et de Pathologies Professionnelles, CHU de Bordeaux, 33076 Bordeaux, France
| | - Dominique Ducint
- Laboratoire de Pharmacologie Clinique et Toxicologie, CHU de Bordeaux, 33076 Bordeaux, France
| | - Karine Titier
- Laboratoire de Pharmacologie Clinique et Toxicologie, CHU de Bordeaux, 33076 Bordeaux, France
| | - Patrick Brochard
- INSERM U1219, ISPED, Université de Bordeaux, 33076 Bordeaux, France; Service de Médecine du Travail et de Pathologies Professionnelles, CHU de Bordeaux, 33076 Bordeaux, France; Univ. of Bordeaux, 33076 Bordeaux, France
| | - Catherine Verdun-Esquer
- INSERM U1219, ISPED, Université de Bordeaux, 33076 Bordeaux, France; Service de Médecine du Travail et de Pathologies Professionnelles, CHU de Bordeaux, 33076 Bordeaux, France
| | - Mathieu Molimard
- Laboratoire de Pharmacologie Clinique et Toxicologie, CHU de Bordeaux, 33076 Bordeaux, France; INSERM U1219, ISPED, Université de Bordeaux, 33076 Bordeaux, France; Univ. of Bordeaux, 33076 Bordeaux, France
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Hon CY, Barzan C, Astrakianakis G. Identification of Knowledge Gaps Regarding Healthcare Workers' Exposure to Antineoplastic Drugs: Review of Literature, North America versus Europe. Saf Health Work 2014; 5:169-74. [PMID: 25516807 PMCID: PMC4266773 DOI: 10.1016/j.shaw.2014.06.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 05/27/2014] [Accepted: 06/02/2014] [Indexed: 01/20/2023] Open
Abstract
We have been examining the issue of healthcare workers' exposure to antineoplastic drugs for nearly a decade and have observed that there appears to be more publications on the subject matter originating from Europe than from North America. The concern is that findings from Europe may not be generalizable to North America because of differences in handling practices, regulatory requirements, and training. Our objective was to perform a literature review to confirm our observation and, in turn, identify gaps in knowledge that warrants addressing in North America. Using select keywords, we searched for publications in PubMed and Web of Science. All papers were initially classified according to the originating continent and then categorized into one or more subject categories (analytical methods, biological monitoring, occupational exposure, surface contamination, and probability of risk/exposure). Our review identified 16 papers originating from North America and 55 papers from Europe with surface contamination being the subject matter most often studied overall. Based on our results, we are of the opinion that North American researchers need to further conduct dermal and/or urinary drug contamination studies as well as assess the exposure risk faced by healthcare workers who handle antineoplastic drugs. Trends in exposure levels should also be explored.
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Affiliation(s)
- Chun-Yip Hon
- School of Occupational and Public Health, Ryerson University, Toronto, Ontario, Canada ; School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Cris Barzan
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada ; Prevention Division, WorkSafeBC, Vancouver, British Columbia, Canada
| | - George Astrakianakis
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
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8
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Analysis of anticancer drugs: a review. Talanta 2011; 85:2265-89. [PMID: 21962644 DOI: 10.1016/j.talanta.2011.08.034] [Citation(s) in RCA: 313] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2011] [Revised: 08/15/2011] [Accepted: 08/16/2011] [Indexed: 01/05/2023]
Abstract
In the last decades, the number of patients receiving chemotherapy has considerably increased. Given the toxicity of cytotoxic agents to humans (not only for patients but also for healthcare professionals), the development of reliable analytical methods to analyse these compounds became necessary. From the discovery of new substances to patient administration, all pharmaceutical fields are concerned with the analysis of cytotoxic drugs. In this review, the use of methods to analyse cytotoxic agents in various matrices, such as pharmaceutical formulations and biological and environmental samples, is discussed. Thus, an overview of reported analytical methods for the determination of the most commonly used anticancer drugs is given.
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Sanson AL, Silva SCR, Martins MCG, Giusti-Paiva A, Maia PP, Martins I. Liquid-liquid extraction combined with high performance liquid chromatography-diode array-ultra-violet for simultaneous determination of antineoplastic drugs in plasma. BRAZ J PHARM SCI 2011. [DOI: 10.1590/s1984-82502011000200017] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
A liquid-liquid extraction (LLE) combined with high-performance liquid chromatography-diode array detection method for simultaneous analysis of four chemically and structurally different antineoplastic drugs (cyclophosphamide, doxorubicin, 5-fluorouracil and ifosfamide) was developed. The assay was performed by isocratic elution, with a C18 column (5 µm, 250 x 4.6 mm) and mobile phase constituted by water pH 4.0- acetonitrile-methanol (68:19:13, v/v/v), which allowed satisfactory separation of the compounds of interest. LLE, with ethyl acetate, was used for sample clean-up with recoveries ranging from 60 to 98%. The linear ranges were from 0.5 to 100 µg mL-1, for doxorubicin and 1 to 100 µg mL-1, for the other compounds. The relative standard deviations ranged from 5.5 to 17.7%. This method is a fast and simple alternative that can be used, simultaneously, for the determination of the four drugs in plasma, with a range enabling quantification of the drugs in pharmacokinetics, bioequivalence and therapeutic drug-monitoring studies.
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Sottani C, Porro B, Comelli M, Imbriani M, Minoia C. An analysis to study trends in occupational exposure to antineoplastic drugs among health care workers. J Chromatogr B Analyt Technol Biomed Life Sci 2010; 878:2593-605. [DOI: 10.1016/j.jchromb.2010.04.030] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2009] [Revised: 04/07/2010] [Accepted: 04/21/2010] [Indexed: 11/25/2022]
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Turci R, Minoia C, Sottani C, Coghi R, Severi P, Castriotta C, Del Bianco M, Imbriani M. Occupational exposure to antineoplastic drugs in seven Italian hospitals: the effect of quality assurance and adherence to guidelines. J Oncol Pharm Pract 2010; 17:320-32. [PMID: 20823049 DOI: 10.1177/1078155210381931] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In health care facilities, dermal contact and inhalation are considered to be the main routes of exposure to cytotoxic antineoplastic drugs (ADs). Hand-to-mouth contamination or accidental needle sticks as well as events due to inadequate disposal may also contribute to exposure. In order to measure the extent of contamination, biological and environmental monitoring are essential tools for routine testing. Moreover, reliable sampling and analytical procedures are required. During the last decade, several methods have been developed and validated. The appropriate analytical techniques were used to quantify even very low levels of some of the more commonly used ADs, such as cyclophosphamide, 5-fluoruracil, taxol, anthracyclines, and platinum-compounds. The main objective of this study is to assess the adherence to existing standards of practice through an effective monitoring program, including environmental and biological measurements. In seven hospitals located in Northern-Central Italy, periodic surveys were scheduled to verify continuing compliance with guidelines over a 5-year period. All biological samples were found to be below detection limits and a progressive, significant decrease in workplace contamination was observed. Our results confirm that a cost-effective monitoring regime, including fast and simple sample pre-treatment procedures, simultaneous determination of the analytes and their metabolites, validated procedures including uncertainty evaluation, and periodic surveys, is the adequate approach for the collection of reliable exposure data and hence for effective intervention.
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Affiliation(s)
- Roberta Turci
- Laboratory for Environmental and Toxicological Testing, Salvatore Maugeri Foundation - via S. Maugeri 10, 27100 Pavia, Italy.
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Sottani C, Rinaldi P, Leoni E, Poggi G, Teragni C, Delmonte A, Minoia C. Simultaneous determination of cyclophosphamide, ifosfamide, doxorubicin, epirubicin and daunorubicin in human urine using high-performance liquid chromatography/electrospray ionization tandem mass spectrometry: bioanalytical method validation. RAPID COMMUNICATIONS IN MASS SPECTROMETRY : RCM 2008; 22:2645-2659. [PMID: 18666202 DOI: 10.1002/rcm.3657] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
A reversed-phase high-performance liquid chromatography (rp-HPLC) system interfaced with an electrospray ionization (ESI) source coupled to tandem mass spectrometry (MS/MS) was developed and validated for the determination of cyclophosphamide (CP), ifosfamide (IF), daunorubicin (DNR), doxorubicin (DXR), and epirubicin (EPI) in human urine. The analysis of samples containing multiple analytes with a dissimilar range of polarities was carried out using a conventional reversed-phase chromatographic BDS Hypersil C8 column. The analytical run was 15 min. The triple quadrupole mass spectrometer was operated in positive ion mode and multiple reaction monitoring (MRM) was used for drug quantification. The method was validated over a concentration range of 0.2 to 4.0 microg.L(-1) for CP, IF, DXR, EPI and 0.15-2.0 microg.L(-1) for DNR in human urine. The lower limit of quantification (LLOQ) was 0.2 microg.L(-1) for CP, IF, EPI and was set at 0.3 and 0.15 microg.L(-1) for DXR and DNR, respectively. The relative standard deviations (RSD%) were <11.2% for inter- and intra-day precisions. The overall accuracy was also within 114.7% for all analytes at the concentrations of the quality control samples. The potential of ionization suppression resulting from the endogenous biological material on the rp-HPLC/MS/MS method was evaluated and measured. The feasibility of the proposed HPLC/ESI-MS/MS procedure was demonstrated by analyzing urine samples from pharmacy technicians and nurses working in hospitals or personnel employed in drug-manufacturing plants.
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Affiliation(s)
- Cristina Sottani
- Laboratory for Environmental and Toxicological Testing, IRCCS Pavia, S. Maugeri Foundation, via S. Maugeri 10, Pavia, Italy.
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Baldo P, Bertola A, Basaglia G, Moneghini M, Sorio R, Zibardi E, Lazzarini R, De Paoli P. A centralized Pharmacy Unit for cytotoxic drugs in accordance with Italian legislation. J Eval Clin Pract 2007; 13:265-71. [PMID: 17378874 DOI: 10.1111/j.1365-2753.2006.00693.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
RATIONALE In May 2002, a centralized Unit for cytotoxic drug preparations [Unità Farmaci Antiblastici (UFA)] was established at the Centro di Riferimento Oncologico, Aviano, Italy. The Unit was created following provisions under Law 626/94 (Legislative Decree - Ministry of Health), governing the safe handling of cytotoxic drugs. New guidelines governing drug preparation ('NBP' standards of preparation) published in Italian Pharmacopoeia (2002, XI Edition) have been mandatory since 2004 and set out rules for proper pharmacy practice applicable also to antineoplastic drug preparations. Aims and objectives To review legislation on cytotoxic drug preparation and compliance within our Unit, to assess current quality levels and identify those areas requiring improvement. METHODS The study reviewed: (1) the organization and equipment of the Unit UFA and its working methodology; (2) written documentation concerning work procedures; (3) the stability and sterility of injectable drug formulations; (4) staff training, occupational exposure and risk management; (5) accidents and mistakes occurring in the UFA service. RESULTS The study showed up the strengths of our Unit and identified those areas which need improvement to guarantee product quality excellence. CONCLUSIONS A critical evaluation of the whole cytotoxic preparation process is a useful method for quality improvements to be initiated. Knowledge regarding risks, techniques, and procedures for handling antineoplastic drugs is growing. Ongoing analysis will ensure greater patient and health care worker safety.
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Affiliation(s)
- Paolo Baldo
- Pharmacy Unit, Centro di Riferimento Oncologico, Aviano, Italy.
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Turci R, Minoia C. Residual Hazard Assessment Related to Handling of Antineoplastic Drugs: Safety System Evolution and Quality Assurance of Analytical Measurement. Ann N Y Acad Sci 2006; 1076:649-56. [PMID: 17119242 DOI: 10.1196/annals.1371.047] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Despite improvement of operating procedures and publication of safety guidelines, contamination is still observed in healthcare settings where antineoplastic drugs (ADs) are handled. Even after cleaning work areas, some residual contamination may still be present. Zero percent contamination is not a realistic goal, but the scientific community should set zero contamination as its main goal. The strategies to reach this objective may be traced based on the followings: (a) a wider number of drugs should be monitored; (b) safety equipment and devices must be available to the workers; (c) the likely source of widespread contamination in workplaces is the safety cabinet; (d) direct determination of the parent drug or its metabolite in urine is the recommended approach because it provides higher sensitivity and specificity; (e) reliable analytical methods are necessary to measure the extent of contamination; and (f) analytical methods intended to be applied for routine testing must be assessed through method validation studies. These studies rely on the determination of overall method performance parameters including uncertainty measurement. Our laboratory has developed and validated a number of analytical methods for the determination of several drugs in environmental and biological samples. Surveys were carried out in several hospitals, and there has been progressive, significant decrease in the number of positive samples, mostly due to the improvement of working procedures and safety measures.
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Affiliation(s)
- Roberta Turci
- Laboratory for Environmental and Toxicological Testing, Salvatore Maugeri Foundation, 27100 Pavia, Italy.
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Barbieri A, Sabatini L, Indiveri P, Bonfiglioli R, Lodi V, Violante FS. Simultaneous determination of low levels of methotrexate and cyclophosphamide in human urine by micro liquid chromatography/electrospray ionization tandem mass spectrometry. RAPID COMMUNICATIONS IN MASS SPECTROMETRY : RCM 2006; 20:1889-93. [PMID: 16715479 DOI: 10.1002/rcm.2527] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
The aim of this study was to develop and validate a novel solid-phase extraction (SPE) liquid chromatography/tandem mass spectrometry (LC/MS/MS) method for the simultaneous determination of two antineoplastic drugs, cyclophosphamide (CP) and methotrexate (MTX), in human urine using trophosphamide as internal standard. The method showed good precision and accuracy (mean RSD 2.8% and 0.9%; bias 2.7% and 2.4% for MTX and CP, respectively). The lower limits of detection obtained, 0.2 microg/L(urine) for MTX and 0.04 microg/L(urine) for CP, were lower than the best previously reported values. The use of a 96-well SPE plate for matrix purification ensures a high throughput (50 samples/day), allowing the routine biological monitoring of CP and MTX as measures of occupational exposure at very low levels.
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Affiliation(s)
- Anna Barbieri
- Safety, Hygiene and Occupational Medicine Service, University of Bologna, via Palagi 9, 40138 Bologna, Italy.
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