Background The different metabolic enzymatic involvement of the drugs used for chemotherapy infusions make them difficult to manage because drugs that build up a poly-chemotherapeutic scheme can increase the cytotoxicity or oppose the desired effect.
Purpose We would like to stimulate the scientific community to start thinking about building a database designed to standardise the infusion sequence of chemotherapy as a foundation for the medical treatment. In order to show all the problems that pharmacists face daily, we conducted a literature search for a scheme used in chemotherapy for lung and ovary cancer: the association between carboplatin and gemcitabine.
Materials and methods We analysed phase I, II and III trials from 1996 to 2006 with a careful evaluation of the documents and considering the pharmacokinetic and pharmacodynamic properties of the two molecules. Most of the studies do not specify in detail the sequence of infusions, they only describe gemcitabine and/or/plus carboplatin in chemotherapeutic regimen or the other way around. Therefore we analysed only the documents that described the infusion sequence in detail.
Results We analysed 16 papers discussing the chemotherapeutic scheme analyses: in 3 studies carboplatin was administered before gemcitabine, 5 studies were designed so that gemcitabine was infused before the carboplatin.
Conclusions With this short paper we have demonstrated that there are a lot of doubts about the ‘right’ infusion sequence of chemotherapy drugs. Our hope is that scientific societies will perform additional clinical trials to find the best sequence in order to standardise medical treatment to ensure high quality.
No conflict of interest.
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