title: Safe handling of oral antineoplastic medications: Focus on targeted therapeutics in the home setting.
abstract: Introduction With the growing number of oral targeted therapies being approved for use in cancer therapy, the potential for long-term administration of these drugs to cancer patients is expanding. The use of these drugs in the home setting has the potential to expose family members and caregivers to them either through direct contact with the drugs or indirectly by exposure to the parent compounds and/or their active metabolites in contaminated patients' waste. Methods A systematic literature review was performed and the known adverse health effect of 32 oral targeted therapeutics is summarized. In particular, the carcinogenicity, genotoxicity, and embryo-fetal toxicity, along with the route of excretion were evaluated. Results Carcinogenicity testing has not been performed on most of the oral targeted therapeutics and the genotoxicity data are mixed. However, the majority of these drugs exhibit adverse reproductive effects, some of which are severe. Currently, available data does not permit the possibility of a health hazard from inappropriate handling of drugs and contaminated patients waste to be ignored, especially in a long-term home setting. Further research is needed to understand these issues. Conclusions With the expanding use of targeted therapies in the home setting, family members and caregivers, especially those of reproductive risk age, are, potentially at risk. Overall basic education and related precautions should be taken to protect family members and caregivers from indirect or direct exposure from these drugs. Further investigations and discussion on this subject are warranted.
authors.affiliation: 1 Israel Ministry of Health, Ramla, Israel.
authors.forename: Yaakov
authors.initials: Y
authors.lastname: Cass
authors.affiliation: 2 Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Cincinnati, OH, USA.
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Connor
authors.affiliation: 3 Expert without affiliation, Jerusalem, Israel.
authors.forename: Alexander
authors.initials: A
authors.lastname: Tabachnik
mesh_terms: D000284:Administration, Oral; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000378:metabolism; D002273:Carcinogens; D017028:Caregivers; D005190:Family; D005333:Fetus / Q000187:drug effects; D006801:Humans; D008506:Medical Waste / Q000009:adverse effects*; D058990:Molecular Targeted Therapy / Q000009:adverse effects*; D009153:Mutagens; D009369:Neoplasms / Q000188:drug therapy*; D012449:Safety; D013723:Teratogens
chemical_list: D000970:Antineoplastic Agents; D002273:Carcinogens; D008506:Medical Waste; D009153:Mutagens; D013723:Teratogens
keywords: Oral antineoplastic medications; home setting; safe handling; targeted therapies