Introduction Multiple myeloma (MM) is associated with an increased venous thromboembolism (VTE) risk despite the existence of current thromboprophylaxis guidelines. Although most patients have an indication for low-molecular-weight heparin (LMWH) based on additional risk factors for VTE, aspirin is still widely prescribed as thromboprophylaxis in newly diagnosed patients with MM. It is unclear why current guidelines are not implemented in daily practice. This qualitative interview study aims to identify which factors influence the choice of thromboprophylaxis in MM. Methods Fifteen Dutch physicians experienced in treating patients with MM were interviewed about the factors influencing their choice of thromboprophylaxis. We conducted semi-structured individual interviews. Participant inclusion was discontinued after reaching data saturation. We performed a thematic analysis using an inductive approach. The findings are reported according to the Consolidated Criteria for Reporting Qualitative Research. Results Three main themes influencing MM thromboprophylaxis were identified. The first theme, “Perception of Patient Experience”, indicated that physicians perceive LMWH as a significant burden for patients. The second theme, “Thrombotic Risk Appraisal”, describes how the VTE risk is often underestimated in clinical practice. The third theme, “Medical System-Level Constraints and Enablers”, highlights how automatic aspirin prescription and the need for clearer guideline recommendations on direct oral anticoagulants (DOACs) influence decision-making. Conclusion The preference for aspirin thromboprophylaxis may be explained by physicians prioritizing patient quality of life, underestimation of VTE risk, and the influence of current guidelines and hospital systems. From a physician's perspective, DOACs could offer a good solution as they represent a potential patient-friendly alternative. However, robust comparative evidence regarding their efficacy and safety is lacking. This study underscores the urgent need for large observational studies or randomized controlled trials evaluating DOACs in MM to guide patient-appropriate thromboprophylaxis in clinical practice.
ObjectiveTo standardise intravenous antineoplastic administration and reduce administration-phase discrepancies by implementing parameterised smart infusion pumps supported by a clinical pharmacist- governed drug library.Data SourcesPump alert logs and structured clinical pharmacist records of administration discrepancies collected during routine care over 12 months following go-live.Data SummaryChemotherapy administration is vulnerable to wrong infusion duration/rate selection and missed drug-specific requirements (e.g., in-line filters and light protection). A multidisciplinary team implemented parameterised smart infusion pumps with a structured library requiring selection of the exact antineoplastic agent prior to infusion. For each agent, validated infusion-time windows were mapped to safe rate ranges and enforced as locked hard limits; mandatory prompts highlighted filter and light-protection requirements where applicable. Clinical pharmacists led drug-library build, validation and change control with oncology/haematology physicians and nursing leadership, supported by staff training and standardised workflow aids. During the 12-month evaluation period, approximately 17,000 chemotherapy days and 40,000 chemotherapy infusions were assessed. Smart pump safeguards identified and enabled correction of 26 near-miss administration discrepancies before infusion initiation, corresponding to 0.15 discrepancies per 100 chemotherapy days. Parameterisation reduced programming steps and shortened set-up time by approximately 30 s per infusion, corresponding to an estimated net nursing time saving of around one hour per day.ConclusionsA clinical pharmacist-led parameterised smart pump programme strengthened standardisation at the point of administration and supported a proactive medication-safety culture in routine practice. This practice-based report provides transferable operational detail on governance and bedside safeguards for oncology pharmacy services.
ObjectiveTo review the challenges associated with oral anticancer drug administration in older adults, focusing on dysphagia, dosage-form manipulation, medication-related risks, acceptability, and oncology-specific safety considerations.Data SourcesA narrative literature review was conducted using PubMed, Scopus and ScienceDirect. Publications from January 2000 to March 2026 were identified using keywords related to geriatric oncology, dysphagia, oral dosage forms, dosage-form manipulation, oral anticancer agents, medication safety, acceptability, and hazardous drugs. Review articles, original studies, professional recommendations and regulatory documents were included.Data SummarySwallowing disorders are common among older adults with cancer and may compromise oral anticancer therapy administration. Dosage-form manipulation practices, including tablet crushing and capsule opening, are frequently used despite their potential effects on drug stability, bioavailability, pharmacokinetics, and therapeutic efficacy. These concerns are amplified by the narrow therapeutic index of many oral anticancer agents and the risk of occupational, caregiver, and environmental exposure to hazardous drugs. Available evidence reveals gaps in standardized administration procedures and limited data supporting alternative administration strategies. A review of selected oral anticancer agents showed substantial variability in formulation constraints, manipulation practices, and supporting evidence. Emerging approaches, including dispersible and orodispersible formulations, multiparticulate systems, mini-tablets, and three-dimensional (3D) printed medicines, may improve treatment acceptability and reduce inappropriate dosage-form manipulation.ConclusionsDysphagia and dosage-form manipulation remain underrecognized challenges in geriatric oncology, with implications for treatment safety, efficacy, adherence, and hazardous-drug exposure. Addressing these issues requires multidisciplinary collaboration, standardized procedures, patient-centered formulation design, and further research to support evidence-based practice.
BackgroundSystemic anticancer cytotoxic therapies (SACT) often have complications that can lead to unexpected hospital attendances usage (UHA) and protocol modifications (PM). UHA have been associated with poorer median survival and increased economic burden on healthcare systems. Our study aims to identify any significant predictors for UHAs and PMs.MethodsOur single centre retrospective cohort study aims to identify any significant predictors for UHAs and PMs. Patient demographics, details of UHA and SACT regimen data were collected for each patient between March 2024 to March 2025. For our univariate analysis of possible predictors, we used chi squared for any association between categorical variables and independent t tests for continuous variables. While for multivariate analysis, binary logistic regression was conducted to identify any significant predictors.Results534 patients were analysed with 218 (40.8%) having stage IV disease. 314 patients (58.8%) had at least one UHA and 378 patients (70.8%) had PMs. There were no significant predictors for UHAs. While patients who progressed on SACT was a predictor for PMs (HR 2.514, 95%CI 1.216-5.198, p = 0.013). Furthermore, progression on SACT (HR 0.441, 95%CI 0.232-0.841, P = 0.013) and line of therapy (HR 0.719, 95%CI 0.567-0.912, P = 0.0006) were predictors for completing all SACT cycles. Finally, age (HR 1.026, 95% CI 1.002-1.051, p = 0.036) and line of therapy (HR 0.679, 95% CI 0.530-0.870, p = 0.002) were predictors for dose reduction.DiscussionLine of therapy was a predictor for patients completing their SACT and undergoing a dose reduction. Potentially, older patients could have an upfront dose reduction to improve their quality of life. Our limitations consisted of our study being a single centre and using retrospective data collection. Future multi centre prospective studies are needed to understand the scale of the problem and validate this study results.
BackgroundRibociclib, a cyclin-dependent kinase (CDK) 4/6 inhibitor used in metastatic breast cancer, is a time-dependent inhibitor of cytochrome P450 (CYP) 3A4. While interactions with direct oral anticoagulants (DOACs) are recognized, interactions with warfarin may be underrecognized.Case PresentationA woman in her late 70's taking warfarin for atrial fibrillation developed a critically elevated international normalized ratio (INR) of 16.4 and epistaxis approximately 2 weeks after initiation of ribociclib for breast cancer. She had been transitioned from apixaban to warfarin approximately 2 months earlier due to concern for a potential interaction between apixaban and ribociclib. Her INR had remained stable prior to ribociclib initiation, with a time in therapeutic range (TTR) of 78%.Management and OutcomeThe patient required reversal with vitamin K and 4-factor prothrombin complex concentrate (4F-PCC). Ribociclib-associated CYP3A4 inhibition was considered the most plausible contributing factor to the critically elevated INR. Warfarin was resumed at a reduced dose with close outpatient monitoring.DiscussionThis case highlights the risk of a clinically significant anticoagulant interaction following ribociclib initiation. Although warfarin allows monitoring via INR, insufficient early monitoring may increase patient risk. Weekly INR monitoring during the first 2 cycles of ribociclib may improve safety.
AimTo gather nurses' perceptions nursing hematologic management on patients undergoing CAR-T cell therapy. A combined approach using statistical analysis and Large Language Model for open-ended questionnaire processing (LLMs) was adopted to analyze and interpret open-ended questionnaire responses, focusing on the critical issues in managing patients' post-CAR T-cell therapy infusion.DesignObservational questionnaire-based survey study.MethodsWe analyzed data through descriptive statistical methods and used generative artificial intelligence to summarize four open-ended answers.ResultsA total of 89 Italian oncology nurses participated in the present study. The semiautomatic analysis of the open-ended responses, using a procedure based on a freely available large language model, allowed us to identify and summarize the main concerns expressed by the professionals regarding the critical issues in managing post-CAR T-cell infusion patients.ConclusionsAddressing the highlighted issues through targeted improvements in staffing, training, and resource allocation could significantly enhance patient outcomes and care quality.
BackgroundHematopoietic stem cell transplantation (HSCT) is vital for treating blood disorders, yet Low- and Middle-Income Countries (LMICs) often lack adequate Bone Marrow Transplant (BMT) pharmacy services. This study aims to reach consensus among oncology pharmacy experts on the essential staff, infrastructure, supplies, and safety/control measures required to establish BMT pharmacy services in LMICs.MethodologyThe Delphi method was employed to evaluate and achieve consensus on BMT pharmacy services at Benjamin Mkapa Hospital in Tanzania, involving 11 oncology pharmacy personnel.ResultsIn the initial round, participants responded to 10 open-ended questions concerning staffing, infrastructure, supplies, medicines, safety, and quality assurance. The second round focused on achieving consensus, breaking down the domains into 14 specific points. Consensus scores varied from 64% (neutral) for safety and quality assurance to 96% for staffing levels, with consensus reached at 66.7%. The third round concentrated on prioritization, identifying staffing and infrastructure as high priorities, which received a score of 46%. Safety and quality assurance garnered the lowest score at 9%. Participants proposed two guidelines, three protocols, and 21 standard operating procedures (SOPs). Additionally, they suggested 14 essential medicines, 56 adjunctive medicines, 22 medical devices, and at least two Class III biosafety cabinets, which are crucial for establishing BMT pharmacy units and HSCT services in resource-limited settings. These resources were categorized into those already established at BMH and those that emerged from participant consensus.ConclusionsThe Delphi findings highlight staffing and infrastructure as top priorities for establishing BMT and HSCT services in resource-limited settings. Addressing safety and quality assurance is also crucial. The recommended guidelines and protocols can enhance service delivery and improve patient outcomes.
ObjectivesAntiblastic Drugs Units (ADUs) ensure safety, appropriateness and sustainability of oncology treatments. Over the last decade, hospital pharmacists have expanded their role from aseptic compounding to advanced clinical pharmacy. This study describes the ten-year evolution of the ADU of ASL Taranto in Southern Italy, focusing on clinical, organisational and strategic value generated from 2014 to 2025.MethodsA retrospective descriptive analysis of activity data, organisational changes and clinical pharmacy services was conducted. Key indicators include compounded preparations, quality systems, technological innovations, service centralisation, CAR-T therapy management, clinical trials, compassionate use programmes and COVID-19 emergency response.ResultsBetween March and December 2014, 17,508 antiblastic preparations were compounded (daily average: 83). Activity increased to 53,300 in 2025 (daily average: 212), representing a 204% increase. The ADU achieved and maintained ISO 9001:2015 certification since 2017. Since 2022, 49 CAR-T therapies were managed, including quality assurance and AIFA registry monitoring. The ADU evolved into a Clinical Trial Centre, supporting six phase II-III trials in 2025, and enabled access to innovative medicines through compassionate use programmes (62 patients in 2025). During COVID-19, the unit served as central hub for vaccine and remdesivir management. Despite a 1194% increase in pharmaceutical expenditure (€2.54 M to €32.87 M), systematic reimbursement management generated €8.92 M in recoveries and savings in 2025 (27.1% of expenditure).ConclusionsThe experience of this ADU illustrates how a structured, quality-driven approach can support the transformation of aseptic compounding into advanced clinical pharmacy. The integration of pharmacists into multidisciplinary oncology teams was associated with strengthened medication safety processes, expanded access to innovation and improved economic sustainability, suggesting a potential reference model for comparable settings.
IntroductionCapecitabine-induced hand-foot syndrome (HFS) is a frequent and clinically relevant toxicity that may impair quality of life and lead to chemotherapy dose reduction or interruption. This study aimed to evaluate the effectiveness, safety, and clinical predictors of response to topical recombinant human epidermal growth factor (rhEGF) gel combined with urea ointment in patients with capecitabine-induced HFS.MethodsThis retrospective case series included a total of 83 patients with colorectal adenocarcinoma who developed Grade II-III capecitabine-induced HFS and received topical rhEGF gel plus urea ointment between January 2022 and December 2025.ResultsThe median age was 61 years, and 49 patients (59.0%) were male. At baseline, 48 patients (57.8%) had Grade II HFS and 35 (42.2%) had Grade III HFS. After 3 weeks of treatment, 67 patients (80.7%) achieved at least a one-grade reduction in HFS severity. The median HFS grade significantly decreased after treatment (Wilcoxon, signed-rank, p < 0.001), with no cases of worsening. Improvements were observed in pain (70/70 affected patients; 100.0%), erythema (73/76; 96.1%), desquamation (60/60; 100.0%), and ulceration (18/24; 75.0% among affected patients). The median time to first documented improvement was 10 days. In an exploratory adjusted model, early treatment initiation within 7 days was associated with higher odds of response, whereas baseline Grade III HFS was associated with lower odds of response. No serious adverse events considered related to treatment were documented.ConclusionsTopical rhEGF gel plus urea ointment was associated with rapid, well-tolerated improvement in capecitabine-induced HFS.
BackgroundCancer chemotherapy is associated with significant deterioration in quality of life (QoL) and challenges in treatment adherence. Mobile health (mHealth) applications represent a promising digital intervention for supporting patients throughout the chemotherapy trajectory.ObjectiveTo systematically evaluate the effectiveness of patient-facing mHealth applications in improving QoL and treatment adherence among adult cancer patients actively undergoing chemotherapy, and to quantify the pooled effect size through meta-analysis.MethodsA systematic search was conducted across seven databases from January 2014 to June 2026. Randomised controlled trials (RCTs), quasi-experimental, and cohort studies enrolling adults receiving chemotherapy with a patient-facing mHealth intervention reporting QoL or adherence outcomes were included.ResultsTwenty-two studies (n = 3505 participants; 14 RCTs, 5 quasi-experimental, 1 cluster-RCT, 1 protocol) across 11 countries were included. Of 19 studies reporting QoL outcomes, 17 (89%) demonstrated statistically significant improvements in favour of the mHealth intervention. The pooled random-effects estimate demonstrated a large, statistically significant effect on QoL (Hedges' g = 0.981, 95% CI: 0.336 to 1.626, P = 0.003; k = 9, n = 939). Medication adherence was significantly improved in five studies. Overall certainty of evidence was rated as moderate (GRADE).ConclusionsPatient-facing mHealth applications produce large, significant improvements in QoL during cancer chemotherapy. Interventions grounded in nursing theory and incorporating real-time clinician feedback yield the largest effects. Integration of mHealth into oncology pharmacy practice models is warranted. Standardised outcome reporting and head-to-head comparative trials are needed.
BackgroundIbrutinib exposure is strongly affected by cytochrome P450 3A4 (CYP3A4) activity. Drug-drug interactions (DDIs) can substantially increase ibrutinib plasma concentrations, requiring major dose reductions in DDI management. This study aimed to assess whether splitting ibrutinib 140 mg tablets is a practical and feasible strategy to adjust ibrutinib dosing in case of DDIs.MethodsIbrutinib 140 mg tablets were split into quarters using a tablet splitter aiming at 35 mg dose units. The obtained quarters were evaluated according to the European Pharmacopoeia requirements for Uniformity of Dosage Units. In addition, Uniformity of Mass, Uniformity of Content, loss of mass, stability of quartered tablets, reproducibility of splitting, usability of the splitting device, and patient instructions were assessed. The expected effects of tablet splitting on ibrutinib exposure were calculated.ResultsA strong correlation between tablet mass and ibrutinib content was observed (r = 0.896; p < 0.0001), indicating uniform distribution of ibrutinib throughout the tablets. Loss of mass was <3% for all tablets, indicating that quartering did not lead to substantial material loss. The mean ibrutinib content was 34.4 mg (range 28.2-40.3 mg). Uniformity of Dosage Units of ibrutinib quarters complied with the European Pharmacopoeia requirements, with an acceptance value of 7.5% against a requirement of ≤15%. Split tablets were stable for at least two weeks under outpatient storage conditions. Patient instructions were considered sufficient and the splitting device was rated user-friendly. The impact of splitting variation on exposure is within the range of interindividual variation in ibrutinib exposure.ConclusionSplitting ibrutinib 140 mg tablets may provide a practical, clinically feasible and patient-friendly strategy to obtain 35 or 70 mg doses of ibrutinib when dose reduction is required in the management of DDIs. The expected exposure variation due to dose variations introduced by tablet splitting is unlikely to be of clinical relevance.
PurposeProton pump inhibitors (PPIs) are often overprescribed in cancer care, leading to unnecessary side effects and increasing healthcare costs. Pharmacists can optimize and improve the rational prescribing of PPIs particularly in low/middle income countries, where such data is limited. We aimed to evaluate how a pharmacist-led education program affects PPIs rational prescribing and deprescribing in cancer patients through adhering to American Gastroenterological Association (AGA) guidelines, documentation of indication, and reducing costs.MethodsThis quasi-experimental study was conducted at a tertiary care cancer hospital in Peshawar, Pakistan from November 2024 to January 2025. Intervention included physician education via CME sessions and weekly AGA guidelines pamphlet. Data related to patient age, type of cancer, PPI prescriptions, indications for use, documentation, other co-prescribed medicines, and costs were collected. Outcomes included guidelines adherence in terms of changes in PPI prescribing, inappropriate PPI use, and the total costs of therapy.ResultsA total of 400 prescriptions (200 pre- and 200 -post intervention) were analyzed. Inappropriate use without proper indication decreased from 34.3% to 14%. Long-term use without a valid reason also declined from 7.3% to 1.8%. The average cost of treatment dropped from PKR 530 ± 428.6 to 336.4 ± 250.8, with p < 0.001. Significant improvements in adherence to multiple AGA Best Practice Advise (BPA) categories were observed, especially in deprescribing PPIs without definitive indications and step-down dosing. The documentation of indications for PPI use improved from 39.3% to 60.7%, with p < 0.001.ConclusionPharmacist-led interventions greatly improved rational PPIs prescribing, enhanced documentation, reduced inappropriate PPI use, and reduced therapy costs in cancer patients. These results support the pharmacist's integration into oncology healthcare team to improve medicine safety, rational use and resource utilization.
BackgroundTriple-negative breast cancer (TNBC) is an aggressive subtype with limited targeted treatment options. Platinum agents, particularly carboplatin's DNA damaging properties suggest efficacy, its impact on survival outcomes and toxicity remains uncertain.MethodsPubMed, Embase, Scopus, Cochrane Library, and ClinicalTrials.gov were searched from inception to February 2026. Phase II/III RCTs comparing carboplatin plus standard chemotherapy with standard therapy alone in TNBC were included. Primary outcomes were disease-free survival (DFS), overall survival (OS), and pathological complete response (pCR). Pooled hazard ratios (HRs) and risk ratios (RRs) were calculated using random-effects models.ResultsTwenty-three trials (n = 8797) were included. Carboplatin significantly improved DFS (HR 0.68, 95% CI 0.60-0.76), OS (HR 0.65, 95% CI 0.53-0.80), and pCR (RR 1.46, 95% CI 1.30-1.64). Improvements were also observed in distant disease-free survival and recurrence-free survival. However, carboplatin was associated with increased hematological toxicities, including anemia, neutropenia, and thrombocytopenia, and higher rates of dose reduction and treatment discontinuation, though treatment-related mortality was not significant.ConclusionCarboplatin-containing chemotherapy improves survival outcomes and pCR in TNBC. Despite increased toxicity, adverse effects are generally manageable. These findings support the incorporation of carboplatin into TNBC treatment, with careful patient selection to balance efficacy and safety.
IntroductionThe residual drug content in empty vials post-compounding is a crucial indicator for assessing the accuracy of intelligent dispensing robots. Excessive residue not only reduces therapeutic efficacy but also increases occupational exposure risks during handling. This study aims to investigate the differences in residual drug levels between intelligent dispensing robotic and manual preparation methods for cytotoxic drugs.MethodThis experimental study was conducted in the Pharmacy Intravenous Admixture Service (PIVAS) of a provincial People's Hospital. Four cytotoxic drugs were prepared using both an intelligent dispensing robotic and manual preparation methods under a designed protocol. High-performance liquid chromatography (HPLC) was used to measure residual drug contents in empty vials. The residual proportions were analyzed and compared under various conditions.ResultsA total of 270 vials were analyzed, including 150 prepared by the intelligent dispensing robot and 120 from manual preparation. The residual drug content in vials prepared by the robot ranged from 1.050 to 29.450 mg, with a residual proportion of 0.73% to 4.90%. For manually prepared vials, the residual drug content ranged from 1.030 to 43.350 mg, with a residual proportion of 0.73% to 8.67%. The residual drug proportion was significantly lower for robotic preparation [2.23% (1.66%, 3.36%)] compared to manual preparation [3.02% (1.52%, 4.40%)] (P < 0.001).ConclusionThis study identified differences in residual drug proportions between robotic and manual compounding. Under the study conditions, robotic compounding resulted in a lower overall residual proportion; however, the direction and variability of the differences varied among drug-packaging combinations. Differences were also observed among formulations with different reconstitution characteristics, stopper types, and container types. These findings reflect the overall performance of the two workflow and provide valuable evidence to support the clinical application and regulatory development of intelligent dispensing robot systems.
BackgroundRecurrent or metastatic head and neck squamous cell carcinoma (R/M HNSCC) has a poor prognosis due to patient rigors, such as malnutrition, uncontrolled comorbidities, age, and performance status. Rapidly evolving treatment paradigms have led to multimodal pharmacotherapy. This study evaluates drug utilization patterns of chemotherapy regimens used in R/M HNSCC patients to optimize evidence-based recommendations.MethodsThis prospective observational study recruited histologically confirmed R/M HNSCC patients aged 18-80 years, with Eastern Cooperative Oncology Group performance status 0-2, treated with palliative intent over one year.ResultsThis drug utilization pattern study recruited 112 patients. The most common chemotherapy regimens (31.19%) were oral triple metronomic chemotherapy followed by low-dose nivolumab plus oral metronomic chemotherapy (27.5%), paclitaxel and carboplatin with triple metronomic chemotherapy (20.5%), and paclitaxel plus carboplatin (19.7%). The median progression-free survival was 9 months (95% CI, 8.5-10.2). Grade 3 adverse events occurred in less than 12% of patients. Full-dose immunotherapy-based combination regimens contribute significantly (81.91%) to the total cost.ConclusionSignificant incongruity exists between NCCN-recommended first-line therapies and resource-constrained setups. The pragmatic use of cost-effective regimens, such as triple metronomic chemotherapy with low-dose nivolumab or as monotherapy, improves survival outcomes, thus optimizing patient care in real-world settings.
IntroductionThe long-term survival impact of adding CDK4/6 inhibitors to adjuvant endocrine therapy for hormone receptor-positive, HER2-negative (HR+/HER2-) early breast cancer remains a subject of active evaluation. We performed an updated meta-analysis incorporating the mature efficacy and survival data to comprehensively evaluate the therapeutic benefit and safety profile of adjuvant CDK4/6 inhibitors.MethodsA systematic review and meta-analysis of phase III randomized controlled trials comparing adjuvant CDK4/6 inhibitors plus endocrine therapy with endocrine therapy alone in patients with HR+/HER2- EBC was conducted. The primary outcomes were invasive disease-free survival (IDFS) and overall survival (OS). Hazard ratios (HRs) with 95% confidence intervals (CIs) were pooled using meta-analytic methods.ResultsFour phase III randomized trials involving 17,784 patients met the inclusion criteria. In the overall analysis, adjuvant CDK4/6 inhibition significantly improved IDFS compared with endocrine therapy alone. In the prespecified analysis restricted to monarchE and NATALEE, adjuvant abemaciclib and ribociclib significantly reduced the risk of invasive disease recurrence (pooled HR 0.69, 95% CI 0.63-0.76; I2 = 0%) and demonstrated a significant overall survival benefit with mature follow-up (pooled HR 0.83, 95% CI 0.73-0.94; I2 = 0%). In contrast, the palbociclib trials (PALLAS and PENELOPE-B) failed to demonstrate improvements in either IDFS or OS. Treatment with CDK4/6 inhibitors was associated with a higher incidence of grade ≥3 adverse events.ConclusionsAbemaciclib and ribociclib significantly improve IDFS and are associated with emerging OS benefits in patients with high-risk HR+/HER2- early high risk breast cancer, whereas palbociclib has not shown comparable efficacy.
Introduction5-Fluorouracil (5-FU) is an antimetabolite widely used in colorectal, gastric, breast, and other solid tumors. Hypersensitivity reactions are uncommon but may be severe.Case ReportWe report a 63-year-old woman with metastatic sigmoid colon cancer who developed an anaphylactic reaction during the second course of a 5-FU-containing regimen, specifically following the bolus infusion. Skin prick and intradermal tests performed four weeks later were negative.Management & OutcomeAs no equally efficacious alternative existed within the planned regimen, rapid intravenous desensitization was performed using a 16-step protocol with four dilution solutions. Desensitization was completed without adverse events, and the subsequent 48-h continuous 5-FU infusion was also well tolerated.DiscussionThis case adds to the limited literature on 5-FU desensitization and underscores its feasibility and safety in agent-dependent patients.
IntroductionDacarbazine is generally well-tolerated, apart from its hematologic toxicities; however, rare and life-threatening anaphylactic reactions have been reported. We aimed to describe a rare case of anaphylactic reaction to dacarbazine following a previously tolerated first dose.Case ReportWe report a case of a 69-year-old male patient with classical Hodgkin lymphoma, who was planned for nivolumab, doxorubicin, vinblastine, and dacarbazine (N + AVD) combination, day 1 and 15 every 28 days. The patient received day 1 of cycle#1, without any complications. On day 15, the patient developed a severe anaphylactic reaction 5 min after the start of dacarbazine infusion. The reaction was manifested by hypoxia, shivering, itching, and laryngeal edema.Management & OutcomePatient required immediate interruption of dacarbazine infusion and received 10 mg of intravenous chlorphenamine and 200 mg of intravenous hydrocortisone initially with no improvement. Hypoxia and laryngeal edema improved following the administration of 0.3 mg intramuscular epinephrine. The patient was transferred to the intensive care unit for close monitoring due to increased risk of biphasic anaphylactic reaction, in which symptoms can recur after initial resolution. Oxygen saturation improved from 82% to 90-93%, and the patient remained hemodynamically stable without complications. Dacarbazine was discontinued. Patient continued nivolumab, doxorubicin, and vinblastine (N + AV) for five cycles, and achieved complete metabolic response.DiscussionThis case highlights that anaphylactic reaction to dacarbazine may occur despite prior tolerance to the first dose. Physicians should suspect reaction during subsequent infusions of dacarbazine, even when initial cycle is tolerated.
IntroductionMany anticancer agents are associated with immediate hypersensitivity reactions, and taxanes are among the most frequently implicated drug class. Although the mechanisms underlying paclitaxel-induced hypersensitivity reactions remain incompletely understood, environmental exposures may influence immune responsiveness. Seasonal variation and associated pollen exposure may modify the risk of paclitaxel-induced hypersensitivity reactions.MethodsThis was a retrospective, single-center, Institutional Review Board-approved review of adult patients who received at least one paclitaxel infusion at our institution between November 20, 2023, and December 31, 2024.ResultsOf 2526 patients included, 554 (22%) experienced a hypersensitivity reaction to paclitaxel. The largest proportion of hypersensitivity reactions occurred during the winter months, with 29% of all hypersensitivity reactions occurring during December, January, and February. In multivariate analysis, however, fall months (September, October, November) were independently associated with increased odds of hypersensitivity to paclitaxel (OR: 1.52; 95% CI: 1.14, 2.02; p=0.029).ConclusionsSeasonal variation was associated with paclitaxel-induced hypersensitivity reactions, with fall months demonstrating increased risk in adjusted analyses. These findings are exploratory and warrant validation in larger, multicenter datasets.
IntroductionOral anticancer medicines (OAMs) play an important role in cancer chemotherapy. As administration is either done by the patient or caregiver, proper knowledge, practices and adherence to OAMs are important.MethodsA cross-sectional study was conducted among 272 patients attending oncology clinics, National Hospital, Galle, Sri Lanka, using an interviewer-administered questionnaire to assess the knowledge, practices and adherence to the OAMs. The study was conducted from December 2023 to October 2024.ResultsMost participants were female (74.26%). The majority (91.54%) were 45 years or older. The most prescribed OAM was anastrozole (40.44%). All the participants knew the frequency of their OAMs. However, only 26.50% were aware of the names of the OAMs. Higher educational attainment showed a weak to moderate positive association with knowledge of OAM dosage regimens (rs = 0.334, p < 0.001), while younger age displayed a weak negative association (rs = -0.180, p = 0.003). Pharmacists were the major source of information (51.10%) on OAMs. The majority of participants (84.90%) reported visiting the emergency department in an accidental overdose. Discontinuation of OAMs was most often due to unavailability (62.75%). More than half of the participants demonstrated moderate adherence to OAMs (54.80%). In contrast, adherence demonstrated a weak positive association with older age (rs = 0.162, p = 0.007), with no significant associations observed with education level or gender.ConclusionThe findings highlight the need for enhanced patient education and pharmacist-led counselling interventions to improve knowledge and adherence to OAMs among oncology patients.
