title: Establishing the optimal nebulization system for paclitaxel, docetaxel, cisplatin, carboplatin and gemcitabine: back to drawing the residual cup.
abstract: BACKGROUND
  Chemotherapy drugs have still the major disadvantage of non-specific cytotoxic effects. Although, new drugs targeting the genome of the tumor are already in the market, doublet chemotherapy regimens still remain the cornerstone of lung cancer treatment. Novel modalities of administration are under investigation such as; aerosol, intratumoral and intravascular.
  
  
  METHODS
  In the present study five chemotherapy drugs; paclitaxel, docetaxel, gemcitabine, carboplatin and cisplatin were nebulized with three different jet nebulizers (Maxineb(®), Sunmist(®), Invacare(®)) and six different residual cups at different concentrations. The purpose of the study was to identify the "ideal" combination of nebulizer-residual cup design-drug-drug loading for a future concept of aerosol chemotherapy in lung cancer patients. The Mastersizer(®) 2000 was used to evaluate the aerosol droplet mass median aerodynamic diameter.
  
  
  RESULTS
  The drug, nebulizer and residual cup design greatly influences the producing droplet size (p<0.005, in each case). However; the design of the residual cup is the most important factor affecting the produced droplet size (F=834.6, p<0.001). The drug loading plays a vital role in the production of the desired droplet size (F=10.42, p<0.001). The smallest droplet size was produced at 8 ml loading (1.26 μm), while it remained the same at 2, 4 and 6 mls of drug loading.
  
  
  CONCLUSIONS
  The ideal nebulizer would be Maxineb(®), with a large residual cup (10 ml maximum loading capacity) and 8 mls loading and the drug with efficient pulmonary deposition would be docetaxel.
authors.affiliation: Pulmonary Department-Oncology Unit, G. Papanikolaou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece. pzarog@hotmail.com
authors.forename: Paul
authors.initials: P
authors.lastname: Zarogoulidis
authors.forename: Dimitris
authors.initials: D
authors.lastname: Petridis
authors.forename: Christos
authors.initials: C
authors.lastname: Ritzoulis
authors.forename: Kaid
authors.initials: K
authors.lastname: Darwiche
authors.forename: Dionysis
authors.initials: D
authors.lastname: Spyratos
authors.forename: Haidong
authors.initials: H
authors.lastname: Huang
authors.forename: Eugene P
authors.initials: EP
authors.lastname: Goldberg
authors.forename: Lonny
authors.initials: L
authors.lastname: Yarmus
authors.forename: Qiang
authors.initials: Q
authors.lastname: Li
authors.forename: Lutz
authors.initials: L
authors.lastname: Freitag
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Zarogoulidis
mesh_terms: D000970:Antineoplastic Agents / Q000737:chemistry*; D016190:Carboplatin / Q000737:chemistry; D002945:Cisplatin / Q000737:chemistry; D003841:Deoxycytidine / Q000031:analogs & derivatives / Q000737:chemistry; D000077143:Docetaxel; D004867:Equipment Design; D009330:Nebulizers and Vaporizers; D017239:Paclitaxel / Q000737:chemistry; D043823:Taxoids / Q000737:chemistry; D000093542:Gemcitabine
chemical_list: D000970:Antineoplastic Agents; D043823:Taxoids; D003841:Deoxycytidine; D000077143:Docetaxel; D016190:Carboplatin; D017239:Paclitaxel; D002945:Cisplatin; D000093542:Gemcitabine
keywords: Chemotherapy; Lung cancer; Nebulizers