Optimizing automated chemotherapy preparation: determining the need for practice review

Objective
Since its installation in July 2023, the Apoteca Chemo© automated drug preparation system has managed 29 of the 59 International Non-proprietary Names (INNs) listed in the chemotherapy preparation unit logbook. The aim was to identify the remaining INNs that can be integrated into the system.

Materials and methods
We reviewed the remaining INNs for integration into robotic software. A robot has intrinsic preparation criteria that must be adhered to. If they cannot be fully applied, preparation with a robot becomes either impossible or risky. These criteria include product withdrawal volume of < 5 mL, solvent bag withdrawal volume of < 10 mL, reconstitution volume of < 5 mL, use of empty bag and one-liter dilution bag, specific reconstitution solvent (ampoule), final preparation in a diluted syringe, and voluminous product vial. All the data were processed using Microsoft Excel^®.

Results
Of the 11 of the 30 remaining INNs, two (ipilimumab and panitumumab) were added to the database, and seven others were integrated without altering current practices. To resolve certain exclusion criteria, alterations in preparation practices were recommended for two INNs (cetuximab and epirubicin). For cetuximab, the preparation method was switched from empty bags to pre-filled bags, following the supplier’s update of the stability data. For epirubicin, smaller vials were referenced, and dilution bag volumes were modified to compensate for solvent withdrawal volumes of < 10 mL. Following the addition of these four INNs to the automated system, preparations were performed without any failures. Finally, 19 INNs were definitively excluded owing to their inability to resolve the exclusion criteria. The INNs may contain numerous criteria, such as—eight were excluded because of < 5 mL product volume, one because of < 10 mL withdrawal volume, one because of < 5 mL reconstitution volume, one because of dilution in a one-liter bag, five because of preparation using an empty bag, one because of a specific solvent, and four because of diluted syringes.

Discussion/Conclusion
he updated booklet enhanced the capacity of robotic system to handle molecules, representing an annual volume of 3,400 preparations. However, this update concerns INNs, rather than robot-handled preparation types. Additionally, the recent installation of novel Chimio 6.0 may facilitate the acceptance of novel preparation forms (5-fluorouracil infusion pump), potentially eliminating certain old exclusion criteria for preparation.

MeSH Terms: robotics, pharmaceutical preparations, chemotherapy