Oral and topic anticancer drug preparation: state of the art, manufacturing, and ambulatory dispensation

Philippe Garrigue*1, Anaïs Breteau*2, Florence Moissette*3, Céline Saint-Laurent*4, Bertrand Pourroy1, Pascale Pisano1 *Co-auteurs
1 CHU La Timone, Marseille,
2 CHU Charles Nicolle, Rouen,
3 Hôpitaux Universitaires de Strasbourg,
4 CH Marne la Vallée

The absence of commercialized anticancer drug presentation dedicated to topic and oral route is a real matter for a couple of indications regarding adults and pediatry in oncology. Clinicians and pharmacists have to refer to a poor litterature to find and provide answers to this need of therapeutic alternative. On the basis of published formulations and stability assays, the pharmacists are most often compelled to use the existing injectable or oral forms to prepare unitary doses (topic carmustine vials for adults, irinotecan syringes for oral route in oncopediatry. Administration at home is one more contraint for safety of use, both for the patient and the family.

In this context, we realized a preliminary survey in France, Belgium and Switzerland to build a state of the art. Then we searched in the litterature for stability and related drug/drug or food/drug interactions data.

We constituted a database with updated formulation and stability data, that we wish to be easy and free access online. We propose to promote pharmaceutical consultations and to dispense a package including gloves and other measures of precaution, and also a medical waste collector. We wrote a complete set of drug-specific leaflets including a reminder of safe use of the preparation, specific advice about the drug conditioning and storing conditions, answers to frequently asked questions. We also wrote a notebook for at-home administrations.

It is critical to take into account the specific parameters affecting the bioavailability (storing conditions, dilution in atypic diluents such as fruit juices or sodas). As an outlook, we would like to complete the stability data with new assays in such diluents considering atypic containers used at home (feeding bottles, spoons,…).

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