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Lema-Atán JÁ, Lendoiro E, Paniagua-González L, Cruz A, López-Rivadulla M, de-Castro-Ríos A. LC-MS-MS Determination of Cytostatic Drugs on Surfaces and in Urine to Assess Occupational Exposure. J Anal Toxicol 2022; 46:e248-e255. [PMID: 36164930 PMCID: PMC9872221 DOI: 10.1093/jat/bkac073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 07/11/2022] [Accepted: 10/19/2022] [Indexed: 02/02/2023] Open
Abstract
The ever-increased usage of cytostatic drugs leads to high risk of exposure among healthcare workers. Moreover, workers are exposed to multiple compounds throughout their lives, leading to cumulative and chronic exposure. Therefore, multianalyte methods are the most suitable for exposure assessment, which minimizes the risks from handling cytostatic drugs and ensures adequate contamination containment. This study describes the development and full validation of two liquid chromatography-tandem mass spectrometry methods for the detection of gemcitabine, dacarbazine, methotrexate, irinotecan, cyclophosphamide, doxorubicinol, doxorubicin, epirubicin, etoposide, vinorelbine, docetaxel and paclitaxel in working surfaces and urine samples. The urine method is the first to measure vinorelbine and doxorubicinol. For surfaces, limits of detection (LOD) and limits of quantification (LOQ) were 5-100 pg/cm2, and linearity was achieved up to 500 pg/cm2. Inaccuracy was between -11.0 and 8.4%. Intra-day, inter-day and total imprecision were <20%, except for etoposide and irinotecan (<22.1%). In urine, LOD and LOQ were 5-250 pg/mL, with a linear range up to 1,000-5,000 pg/mL. Inaccuracy was between -3.8 and 14.9%. Imprecision was <12.4%. Matrix effect was from -58.3 to 1,268.9% and from -66.7 to 1,636% in surface and urine samples, respectively, and extraction efficiency from 10.8 to 75% and 47.1 to 130.4%, respectively. All the analytes showed autosampler (6°C/72 h), freezer (-22°C/2 months) and freeze/thaw (three cycles) stability. The feasibility of the methods was demonstrated by analyzing real working surfaces and patients' urine samples. Contamination with gemcitabine, irinotecan, cyclophosphamide, epirubicin and paclitaxel (5-4,641.9 pg/cm2) was found on biological safety cabinets and outpatients' bathrooms. Analysis of urine from patients under chemotherapy identified the infused drugs at concentrations higher than the upper LOQ. These validated methods will allow a comprehensive evaluation of both environmental and biological contamination in hospital settings and healthcare workers.
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Affiliation(s)
- José Ángel Lema-Atán
- Toxicology Service, Institute of Forensic Sciences, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Elena Lendoiro
- Toxicology Service, Institute of Forensic Sciences, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Lucía Paniagua-González
- Toxicology Service, Institute of Forensic Sciences, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Angelines Cruz
- Toxicology Service, Institute of Forensic Sciences, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Manuel López-Rivadulla
- Toxicology Service, Institute of Forensic Sciences, University of Santiago de Compostela, Santiago de Compostela, Spain
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Kåredal M, Jönsson R, Wetterling M, Björk B, Hedmer M. A quantitative LC-MS method to determine surface contamination of antineoplastic drugs by wipe sampling. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2022; 19:50-66. [PMID: 34723774 DOI: 10.1080/15459624.2021.2000617] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The main objective was to develop a wipe sampling test to measure surface contamination of the most frequently used antineoplastic drugs (ADs) in Swedish healthcare and, furthermore, to develop an analysis method sensitive enough to assess low levels of contamination. Two wipe sampling tests with separate sample processing methods assessing (i) cyclophosphamide (CP), ifosfamide (IF), 5-fluorouracil (5-FU), etoposide (ETO), gemcitabine (GEM) and cytarabine (CYT) (Wipe Test 1); and (ii) GEM, CYT and methotrexate (MTX) (Wipe Test 2), respectively, were developed by optimization of absorption and extraction efficiencies using different wipe tissue materials, tissue wetting solution, and extraction solvents. A fast liquid chromatography tandem mass spectrometry method was developed for simultaneous detection of the studied ADs. The limit of quantification for the method was between 0.04 to 2.4 ng/wipe sample (0.10 to 6.1 pg/cm2 for an area of 400 cm2) and at 50 ng/sample the within-day precision was between 1.3 and 15%, and the accuracy between 102 and 127%. Wipe Test 1 was applied in an assessment of cleaning efficiency of five different cleaning solutions (formic acid, water, sodium hydroxide, ethanol, and sodium dodecyl sulfate (SDS) for removal of ADs from surfaces made of stainless steel or plastic. For CP, IF, 5-FU, GEM, and CYT 92% of the AD were removed regardless of surface and cleaning solution. In conclusion, a user-friendly assessment method to measure low levels of seven ADs in the work environment was developed and validated. Assessment of the decontamination efficiency of cleaning solutions concerning removal of ADs from stainless steel showed that efficiencies differed depending on the AD with water being the least effective cleaning agent. The results suggests that a combination of different cleaning agents including detergent and a solution with an organic component would be optimal to efficiently remove the measured ADs from surfaces in the workplace.
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Affiliation(s)
- Monica Kåredal
- Department of Occupational and Environmental Medicine, Region Skåne, Lund, Sweden
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Rebecca Jönsson
- Department of Occupational and Environmental Medicine, Region Skåne, Lund, Sweden
| | - Maria Wetterling
- Department of Occupational and Environmental Medicine, Region Skåne, Lund, Sweden
| | - Birgitta Björk
- Department of Occupational and Environmental Medicine, Region Skåne, Lund, Sweden
| | - Maria Hedmer
- Department of Occupational and Environmental Medicine, Region Skåne, Lund, Sweden
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden
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Cytostatics in Indoor Environment: An Update of Analytical Methods. Pharmaceuticals (Basel) 2021; 14:ph14060574. [PMID: 34204005 PMCID: PMC8232629 DOI: 10.3390/ph14060574] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 06/08/2021] [Accepted: 06/11/2021] [Indexed: 11/30/2022] Open
Abstract
Periodic and adequate environmental monitoring programs are crucial to assess and reduce the occupational exposure of healthcare workers to cytostatics. The analytical methods employed should be rapid, reliable, sensitive, standardized, and include multiple compounds. A critical overview of recent overall procedures for surface and air contamination with cytostatics in workplace settings is presented, with a focus on sampling, sample preparation, and instrumental considerations. Limitations are also addressed and some recommendations and advice are provided. Since dermal absorption is the main exposure route, surface contamination is the preferred indicator of biological uptake and its methods have significantly improved. In contrast, cytostatics’ inhalation is rare; thus, air contamination has been poorly studied, with little improvement. Still, some elements of the analytical methods have not been extensively explored, namely: the amount of wetting solution, the extraction procedure, surface chemistry and roughness, recovery studies from specific surfaces, and cytostatics stability (in surfaces and during shipping and storage). Furthermore, complete validation data (including precision, accuracy, and instrumental and method detection limits) and estimation of global uncertainty are still lacking in most studies, thus preventing method comparison and proposal of standardized procedures.
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Bláhová L, Kuta J, Doležalová L, Kozáková Š, Krovová T, Bláha L. The efficiency of antineoplastic drug contamination removal by widely used disinfectants-laboratory and hospital studies. Int Arch Occup Environ Health 2021; 94:1687-1702. [PMID: 33738516 DOI: 10.1007/s00420-021-01671-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 02/12/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Antineoplastic drugs (ADs) pose risks to healthcare staff. Surface disinfectants are used in hospitals to prevent microbial contamination but the efficiency of disinfectants to degrade ADs is not known. We studied nine disinfectants on ten ADs in the standardized laboratory and realistic in situ hospital conditions. METHODS A survey in 43 hospitals prioritized nine most commonly used disinfections based on different ingredients. These were tested on inert stainless steel and in situ on contaminated hospital flooring. The effects against ten ADs were studied by LC-MS/MS (Cyclophosphamide CP; Ifosfamide IF; Capecitabine CAP; Sunitinib SUN; Methotrexate MET; Doxorubicin DOX; Irinotecan IRI; Paclitaxel PX; 5-Fluorouracil FU) and ICP-MS (Pt as a marker of platinum-based ADs). RESULTS Monitoring of the floor contamination in 26 hospitals showed that the most contaminated are the outpatient clinics that suffer from a large turnover of staff and patients and have limited preventive measures. The most frequent ADs were Pt, PX, FU and CP with maxima exceeding the recommended 1 ng/cm2 limit by up to 140 times. IRI, FU, MET, DOX and SUN were efficiently removed by hydrolysis in clean water and present thus lower occupational risk. Disinfectants based on hydrogen peroxide were efficient against PX and FU (> 70% degradation) but less against other ADs, such as carcinogenic CP or IF, IRI and CAP. The most efficient were the active chlorine and peracetic acid-based products, which however release irritating toxic vapors. The innovative in situ testing of ADs previously accumulated in hospital flooring showed highly problematic removal of carcinogenic CP and showed that alcohol-based disinfectants may mobilize persistent ADs contamination from deeper floor layers. CONCLUSION Agents based on hydrogen peroxide, peracetic acid, quaternary ammonium salts, glutaraldehyde, glucoprotamine or detergents can be recommended for daily use for both disinfection and AD decontamination. However, they have variable efficiencies and should be supplemented by periodic use of strong chlorine-based disinfectants efficient also against the carcinogenic and persistent CP.
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Affiliation(s)
- Lucie Bláhová
- Faculty of Science, Masaryk University, RECETOX, Kamenice 753/5, Building D29, 62500, Brno, Czech Republic
| | - Jan Kuta
- Faculty of Science, Masaryk University, RECETOX, Kamenice 753/5, Building D29, 62500, Brno, Czech Republic
| | - Lenka Doležalová
- Masaryk Memorial Cancer Institute, Žlutý kopec 7, 65653, Brno, Czech Republic
| | - Šárka Kozáková
- Masaryk Memorial Cancer Institute, Žlutý kopec 7, 65653, Brno, Czech Republic.,University Hospital Brno, Jihlavská 20, 62500, Brno, Czech Republic
| | - Tereza Krovová
- Faculty of Science, Masaryk University, RECETOX, Kamenice 753/5, Building D29, 62500, Brno, Czech Republic
| | - Luděk Bláha
- Faculty of Science, Masaryk University, RECETOX, Kamenice 753/5, Building D29, 62500, Brno, Czech Republic.
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Acramel A, Chouquet T, Plé A, Sauvageon H, Mourah S, Jouenne F, Goldwirt L. Development and validation of a liquid chromatography tandem mass spectrometry quantification method for 14 cytotoxic drugs in environmental samples. RAPID COMMUNICATIONS IN MASS SPECTROMETRY : RCM 2020; 34:e8594. [PMID: 31519060 DOI: 10.1002/rcm.8594] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 09/06/2019] [Accepted: 09/06/2019] [Indexed: 06/10/2023]
Abstract
RATIONALE Cytotoxic drug preparation in hospital pharmacies is associated with chronic occupational exposure leading to a risk of adverse effects. The objective was to develop and validate a quantification method for the following cytotoxic drugs in environmental wipe samples: cyclophosphamide, ifosfamide, cytarabine, dacarbazine, docetaxel, paclitaxel, doxorubicin, epirubicin, etoposide, 5-fluorouracil, gemcitabine, irinotecan, methotrexate and pemetrexed. METHODS The quantification method was developed using liquid chromatography coupled to tandem mass spectrometry and a wiping technique using viscose swabs. Linearity, accuracy, precision, limit of quantification, specificity and stability were assessed, from swab desorbed solution, to validate the analytical method, with respect to ICH guidelines. Environmental samples were collected by wiping five work surfaces of 225 cm2 with viscose swabs, during three days. RESULTS The quantification method was linear over the calibration range with a lower limit of quantification ranging from 0.5 to 5.0 ng mL-1 depending on the cytotoxic drug. The intra-day and inter-day relative biases were below 1.5% and 13.5%, respectively. This method was successfully applied to surface-wipe sampling and environmental contaminations ranged from 0.7 to 1840.0 ng cm-2 for the most contaminated areas. CONCLUSIONS This quantification method for 14 cytotoxic drugs was successfully applied to environmental contamination monitoring and could therefore be a useful tool for monitoring and toxicological studies.
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Affiliation(s)
- Alexandre Acramel
- Pharmacology Department, Saint-Louis Hospital, AP-HP, 1 Avenue Claude Vellefaux, F-75010, Paris, France
| | - Thibaut Chouquet
- Pharmacology Department, Saint-Louis Hospital, AP-HP, 1 Avenue Claude Vellefaux, F-75010, Paris, France
| | - Alain Plé
- Pharmacology Department, Saint-Louis Hospital, AP-HP, 1 Avenue Claude Vellefaux, F-75010, Paris, France
| | - Hélène Sauvageon
- Pharmacology Department, Saint-Louis Hospital, AP-HP, 1 Avenue Claude Vellefaux, F-75010, Paris, France
- Pharmacy Department, Saint-Louis Hospital, AP-HP, 1 Avenue Claude Vellefaux, F-75010, Paris, France
- INSERM UMR S976, Université de Paris, Paris, France
| | - Samia Mourah
- Pharmacology Department, Saint-Louis Hospital, AP-HP, 1 Avenue Claude Vellefaux, F-75010, Paris, France
- INSERM UMR S976, Université de Paris, Paris, France
| | - Fanélie Jouenne
- Pharmacology Department, Saint-Louis Hospital, AP-HP, 1 Avenue Claude Vellefaux, F-75010, Paris, France
- INSERM UMR S976, Université de Paris, Paris, France
| | - Lauriane Goldwirt
- Pharmacology Department, Saint-Louis Hospital, AP-HP, 1 Avenue Claude Vellefaux, F-75010, Paris, France
- INSERM UMR S976, Université de Paris, Paris, France
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Guichard N, Guillarme D, Bonnabry P, Fleury-Souverain S. Antineoplastic drugs and their analysis: a state of the art review. Analyst 2017; 142:2273-2321. [DOI: 10.1039/c7an00367f] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
We provide an overview of the analytical methods available for the quantification of antineoplastic drugs in pharmaceutical formulations, biological and environmental samples.
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Affiliation(s)
- Nicolas Guichard
- Pharmacy
- Geneva University Hospitals (HUG)
- Geneva
- Switzerland
- School of Pharmaceutical Sciences
| | - Davy Guillarme
- School of Pharmaceutical Sciences
- University of Geneva
- University of Lausanne
- Geneva
- Switzerland
| | - Pascal Bonnabry
- Pharmacy
- Geneva University Hospitals (HUG)
- Geneva
- Switzerland
- School of Pharmaceutical Sciences
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Rani S, Malik AK, Kaur R, Kaur R. A Review for the Analysis of Antidepressant, Antiepileptic and Quinolone Type Drugs in Pharmaceuticals and Environmental Samples. Crit Rev Anal Chem 2016; 46:424-42. [DOI: 10.1080/10408347.2016.1141670] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Susheela Rani
- Department of Chemistry, Punjabi University, Patiala, Punjab, India
| | | | - Ramandeep Kaur
- Department of Chemistry, Punjabi University, Patiala, Punjab, India
| | - Ripneel Kaur
- Department of Chemistry, Punjabi University, Patiala, Punjab, India
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Müller-Ramírez C, Squibb K, McDiarmid M. Accessible analytical methodology for assessing workplace contamination of antineoplastic drugs in limited-resource oncology health-care settings. J Anal Sci Technol 2016. [DOI: 10.1186/s40543-016-0091-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Zhu RH, Li HD, Cai HL, Jiang ZP, Xu P, Dai LB, Peng WX. Validated HILIC-MS/MS assay for determination of vindesine in human plasma: Application to a population pharmacokinetic study. J Pharm Biomed Anal 2014; 96:31-6. [PMID: 24721203 DOI: 10.1016/j.jpba.2014.03.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 03/11/2014] [Accepted: 03/13/2014] [Indexed: 10/25/2022]
Abstract
The first HILIC-tandem mass spectrometry (MS/MS) method for determination of vindesine (VDS) in human plasma using vinorelbine as an internal standard (IS) has been developed and validated. Plasma samples clean-up consisted of solid phase extraction with a strata™-X column. The compounds were separated on a HILIC column with an isocratic mobile phase consisting of acetonitrile and 15mM ammonium acetate buffer containing 0.15% formic acid (80:20, v/v). The detection was performed on a triple quadrupole tandem mass spectrometer via electrospray positive ionization (ESI(+)). The ion transitions recorded in multiple reaction monitoring mode were m/z 754.6→123.8 for VDS and 779.4→323.3 for IS, respectively. Linear calibration curves were obtained in the concentration range of 0.3-28ng/ml and the lower limit of quantification for VDS was 0.3ng/ml. The coefficient of variation of the assay precision was less than 13%, and the accuracy exceeded 96%. The developed assay method was successfully applied for the evaluation of population pharmacokinetics of VDS after intravenous infusion of Xi Ai Ke Vial(®) (3mg of Vindesine Sulfate for Injection) to Chinese Han subjects with hematological malignant disorders.
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Affiliation(s)
- Rong-Hua Zhu
- Clinical Pharmacy and Pharmacology Research Institute, the Second Xiang-Ya Hospital, Central-South University, Changsha, Hunan Province 410011, People's Republic of China; School of Pharmacy, Central-South University, Changsha 410005, People's Republic of China.
| | - Huan-De Li
- Clinical Pharmacy and Pharmacology Research Institute, the Second Xiang-Ya Hospital, Central-South University, Changsha, Hunan Province 410011, People's Republic of China
| | - Hua-Lin Cai
- Clinical Pharmacy and Pharmacology Research Institute, the Second Xiang-Ya Hospital, Central-South University, Changsha, Hunan Province 410011, People's Republic of China
| | - Zhi-Ping Jiang
- Laboratory of Clinical Pharmacology, Department of Hematology, Xiang-Ya Hospital, Central-South University, Changsha 410008, People's Republic of China
| | - Ping Xu
- Clinical Pharmacy and Pharmacology Research Institute, the Second Xiang-Ya Hospital, Central-South University, Changsha, Hunan Province 410011, People's Republic of China
| | - Li-Bo Dai
- Clinical Pharmacy and Pharmacology Research Institute, the Second Xiang-Ya Hospital, Central-South University, Changsha, Hunan Province 410011, People's Republic of China; School of Pharmacy, Central-South University, Changsha 410005, People's Republic of China
| | - Wen-Xing Peng
- Clinical Pharmacy and Pharmacology Research Institute, the Second Xiang-Ya Hospital, Central-South University, Changsha, Hunan Province 410011, People's Republic of China
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