Background Prescription and production of chemotherapies are generally based on body surface area, as recommended by the literature. However, standardisation of doses of chemotherapy (dose-banding/DB) has shown benefits for patients and better cost management Advantages of DB of chemotherapy are: reduction in variation of doses, medicine waste, patient waiting time and medication errors; increased pharmacy capacity for chemotherapy, manufacturing of complex compounds and participation in clinical trials; and uniform requirements in presentation and doses.
Purpose Determine which of the drugs compounded in our centralised chemotherapy production unit were potential candidates for DB for adults, while guaranteeing patient safety and meeting the needs of physicians, pharmacists and nurses.
Material and methods We extrapolated from our IT system all the adults’ chemotherapy protocols containing gemcitabine active substances, in order to analyse the doses most commonly used.
Dose-banding is based on the latest version of the NHS National Dose-banding Table (2016).1 Sometimes the same protocols are used for different indications and with different doses, therefore we considered them separately. We subdivided the schemes for department, pathology and banded dose.
Results Our centralised chemotherapy production recently started using DB gemcitabine in 19 protocols. The gynaecology department uses 63% of the schemes, for the following indications: ovarian, cervical and endometrial cancer. They foresee the administration of 1000 mg of DB gemcitabine, and uterine leiomyosarcoma (900 mg DB gemcitabine). The medical oncology department uses 37% of the schemes, for indications such as: biliopancreatic cancer (1000 mg DB gemcitabine), metastatic breast cancer (800 mg DB gemcitabine), mesothelioma and non-small-cell lung carcinoma (1250 mg DB gemcitabine). In most of the cases, gemcitabine is administered on the first and eighth day of a 21 day chemotherapeutic cycle and associated with other active substances: bevacizumab, carboplatinum, cisplatinum, dacarbazine, docetaxel and oxaliplatinum.
Conclusion The standardisation of chemotherapeutic doses promotes the rationalisation of pharmacy activity and allows the preparation of batches and acceleration of preparation processes. Efficiency and automation also ensure safety and quality control on chemotherapeutic products. Further studies are needed to investigate product stability and develop an alternative way of planning chemotherapy production.
References and/or acknowledgements 1. National Dose Banding Table. https://www.england.nhs.uk/wp-content/uploads/2018/04/national-tables-6-mgml-v2.pdf
2. Guidelines for the Dose Banding of Cancer Chemotherapy NECN dose banding guidelines version 2.0 Nov 15.
No conflict of interest.
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