Dose-banding for chemotherapy in Paediatrics : an avenue worth exploring

Objectives

Dose standardization of anticancer drugs is a concept that is currently used in chemotherapy production units. Yet this method is not recommended in paediatric patients because this population is very heterogeneous. The prescription of anticancer drugs according to body surface area (BSA) leads to the production of many different doses. The aim of this study was to reorganize our production activity and to optimize chemotherapy production in order to reduce processing time.

Materials and methods

The first step was to determine the criteria to select drugs suitable for dose banding. Five criteria were important: easy preparation, long-term stability, high production, low dose variability and low production cost. The second step was to choose the rounded doses for the selected drugs. Rounded doses and calculated theoretical doses according to BSA should not vary by more than 5 to 10%.

Results

According to the selection criteria we selected two drugs: vincristine and methotrexate (MTX) administered by intrathecal route (IT). Vincristine preparations represent 7% of our yearly activity (700 preparations/year).Vincristine matched the required criteria for dose standardization: long-term stability, low dose variability and high production. Six rounded doses were chosen and the banded doses were determined with a variation of 10%.

MTX by IT is also a large part of our activity (900 preparations/year). Conveniently, MTX doses given by IT only depend on the patient’s age. We assessed the MTX dose distribution and thus selected the most prescribed: 12 mg and 15 mg.

Discussion / Conclusion

This study allowed us to improve the organization of our production activity. Indeed, the introduction of batch production for two different doses of MTX IT and six rounded doses of vincristine definitely shortens dispensing time, reduces the number of preparations outside business hours and makes it possible to reallocate non-administered preparations.