Standardization of the infusion sequence of antineoplastic drugs used in the treatment of breast and colorectal cancers

Abstract

The definition of antineoplastic administration sequences can help planning of therapeutic regimens in a more rational way, and thus optimize chemotherapy effects on patients, increasing efficacy and reducing toxic effects. In this way, this study aimed to evaluate the infusion order of antineoplastic agents of the main therapeutic protocols used in the treatment of colorectal and breast cancer which are used in a tertiary hospital, identifying possible interactions dependent on the infusion sequence. For the definition of protocols adopted in the hospital, medical prescriptions were used in the period of January to March 2016 and a literature review was conducted to search for studies assessing the sequence of administering the selected regimens. The databases used were SciELO, LILACS and MEDLINE, in addition to Micromedex Solutions® and UpToDate®. A total of 19 protocols were identified for antineoplastic therapy, 11 for colorectal cancer and 8 for breast cancer. The selected articles provided evidence for administration order of 19 protocols, and three protocols did no report relevance of infusion sequence. Sequence-dependent interactions were mainly related to toxicity, pharmacokinetics and efficacy of the drug combination. The definition of the infusion sequence has a great impact on the optimization of therapy, increasing efficacy and safety of the protocols containing combined antineoplastic therapies.

Taxanes – The Backbone of Medical Oncology

“…Table 3 compiles the sequencing of a few common drugs used in combination with taxanes. [33,34] Cabazitaxel is approved for use as a single agent, hence there is limited data on sequencing. In a single phase 1/2 study of cabazitaxel with carboplatin, there is no specific mention of the sequencing of the two drugs.…”

Risk factors to port-a-cat damage/removal in patients in antineoplastic chemotherapy: a retrospective observational study

“…The proposed treatment is with vesicant/ irritant drug infusions of extended duration (greater than six months) or patients with a compromised venous network or challenging access 5 . Enabling the reduction of pain and discomfort of multiple peripheral punctures without restricting the patients' activities, port-a-cath catheters allow greater patient independence during infusion therapy and contribute to a better quality of life for these patients 6 .…”

Perfil de interações medicamentosas de Agentes Antineoplásicos Orais (AAOs) dispensados para pacientes oncológicos

“…Para o tratamento do câncer, existem várias linhas terapêuticas que são utilizadas de acordo com o tipo e o avanço da neoplasia, são elas: cirurgia, radioterapia, transplantes, imunoterapia e quimioterapia. Dentre estas, a quimioterapia ainda é o tratamento mais adotado em protocolos médicos nos hospitais, ocorrendo mediante o uso de fármacos antineoplásicos por via oral (VO) ou endovenosa (EV) (Katabathina, et al, 2016;Campos et al, 2017;Ozverel, Karaboz & Nalbantsoy, 2017;Tohme, Simmons & Tsung, 2017;Silva, Giugliano et al, 2018;Carlotto & Rotta, 2018;Pisconti, et al, 2018;.…”