PP-024 The automated compounding of paclitaxel albumin as a sustainable alternative to the traditional compounding

Abstract

Background Paclitaxel albumin is indicated for the treatment of metastatic carcinoma of breast after failure of anthracycline therapy. It is notoriously a delicate drug to handle because it is a suspension with high tendency to foam. According to the information sheet, the drug reconstitution requires particularly attention during solvent injection. Furthermore, the vial needs to stand for 5 and 15 min, respectively before and after shaking, to reduce the foam. As a consequence, the therapy compounding appears laborious and demanding for technicians. Purpose To automate the compounding of Abraxane with APOTECAchemo and analyse the related performances. Materials and methods The manual procedure was deeply analysed to evaluate the feasibility to robotize the compounding of Abraxane. 10 preparations are compounded manually, according to the data sheet. Afterwards, 10 preparations of Abraxane were carried out with APOTECAchemo, following the standard procedure of the system. However, the vials were left to rest for 10 min after reconstitution, before going on with the compounding. The preparations are analysed in terms of dosage accuracy and compounding time. Results The preparations compounded manually showed an average dosage error of 1.5% and a compounding time of 30 min. The dosage accuracy of preparations done automatically was -0.5%. The total compounding time resulted in 22 min for preparation: 7 min for reconstitution of 2 vials, 10 min for vial standing and 5 min for compounding. The 10-minute rest time resulted enough to significantly reduce the foam. Dosage accuracy of the automatic procedure resulted similar or better than the manual compounding. In contrast, the use of APOTECAchemo implied a notable reduction of compounding time of 26%. Conclusions The automation of Abraxane preparation resulted feasible and sustainable. Because the dosage accuracy of APOTECAchemo is comparable with manual activity and compounding time is even shorter, the automatic compounding represents an easy and convenient alternative to the traditional practice. No conflict of interest.

Automated compounding technology and workflow solutions for the preparation of chemotherapy: a systematic review

“…A total of 5797 unique citations were identified in the electronic searches and after removal of 622 duplicates, 5175 articles were screened by title and abstract. In total, 5103 articles were excluded, and 72 articles were potentially relevant and following full publications review, 18 publications were included 14–31. Hand searching yielded an additional seven publications for inclusion 32–38.…”

“…Therefore, a total of 25 publications met the inclusion criteria (figure 1). 14–38 All studies were published from 2009 onwards. A summary of study design and results is provided in the online supplementary file, table 2.…”

“…Seven publications reporting on chemotherapy workflow software were included in the SR: six publications reporting on Cato15–17 33 34 38 and one publication reporting on Diana 35. In comparison, 18 publications reporting on robotic compounding systems were included; 12 publications reporting on APOTECAchemo14 18–27 32; 5 publications reporting on CytoCare28–31 36 and 1 on RIVA 37. The quality of the included primary studies (see online supplementary file, table 3) was generally graded as moderate or weak due to the absence of randomised controlled study designs 39…”

“…APOTECAchemo was the most comprehensively studied robot 14 18–27 32. A single study reported the progressively robotised preparation of chemotherapy from 2007 (first generation) to 2011 (third generation) 22 23.…”

“…Results highlighted variability in the dose accuracy of the robot for different classes of chemotherapy (figure 2). 18 19 22 23 25 26 32 For example, a single study reported the mean relative errors of compounding with APOTECAchemo for trastuzumab were −3.7% compared with 2.54% for etoposide 19. Further, a study reported that the dose accuracy of compounding with APOTECAchemo for paclitaxel oleate was −0.28% compared with −3.3% for a docetaxel combination 25…”