Accessible analytical methodology for assessing workplace contamination of antineoplastic drugs in limited-resource oncology health-care settings

Abstract

Background: Environmental monitoring of workplaces where antineoplastic drugs are handled constitutes an essential tool to assess occupational exposures among health-care workers. Consequently, availability of simple, sensitive, and affordable analytical methodologies is needed, particularly in health-care settings with limited resources that restrict environmental monitoring studies. Methods: Previously validated methodologies for simultaneous determination of ifosfamide, cyclophosphamide, and paclitaxel were modified and re-validated in order to create a more sensitive and more accessible liquid chromatography-based analytical method for measuring levels of workplace contamination generated by the handling of antineoplastic drugs in oncology healthcare settings with limited resources. Results: An HPLC-UV methodology was developed and validated to simultaneously determine ifosfamide, cyclophosphamide, and paclitaxel in field wipe samples collected from oncology health-care settings with limited resources. Solid-phase extraction was incorporated to concentrate analytes and improve their detection and quantification. Adequate limits of detection for ifosfamide (0.02 ng/cm 2 ), cyclophosphamide (0.1 ng/cm 2 ), and paclitaxel (0.03 ng/cm 2 ) were obtained. Also, mean recoveries between 88.7 and 96.2 % were achieved. Conclusions: The analytical method described here using a more widely available instrumentation provides an excellent alternative to LC-MS when establishing workplace contamination levels produced by the handling of antineoplastic drugs in non-high-income country oncology health-care settings.

Cytostatics in Indoor Environment: An Update of Analytical Methods

“…A similar behavior for 5FU was also reported by Tuerk et al [35]. Müller-Ramírez and his team investigated the stability of CYC, IFO and PAC on wiping filters at −20 • C and on solid-phase extraction (SPE) cartridges at 20 • C for a period of two months, concluding that no significant decrease of recoveries were observed [10].…”

“…From the aforementioned search, 18 articles were categorized as analytical methods: 16 for surface contamination [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] and two for air contamination [26,27]. The other two articles will not be further examined here as they refer to non-analytical methods for surface contamination assessment [28,29].…”

“…The prevailing reasons for inclusion were their common/frequent use in chemotherapy preparations [11,12,14,20,22,23] and a requirement to include several pharmacological classes in the methodology being developed [11,15,16,20,21,25]. Some also based their choice on IARC classification [10,19,25], on partner hospital's practice [10,13,25] and whether there existed previous studies or documented toxicity regarding proposed cytostatics [10,11]. Still, three articles did not provide any rationale for their choices [17,18,24].…”

“…As can be seen in Table 2, three main sampling devices have been used to extract cytostatics from surfaces: wipes/tissues [11,16,18,20,23], cellulose filter papers [10,14,17,19,22,23,25], and swabs [14,21,22,24].…”

“…For the studies under review, the IDLs for CYC vary between 0.1 and 100 pg/cm 2 . The highest limit was reported by Müller-Ramírez et al, who proposed the determination of CYC, IFO, and PAC in surface extracts by LC in combination with ultraviolet detector [10]. The method comprises a SPE step before instrumental analysis, which allowed achieving tenfold concentration factors, but resulting IDLs were still slightly higher than those provided by LC-MS/MS.…”