Ethanol-induced symptoms in patients receiving gemcitabine diluted from a concentrate for solution for infusion containing ethanol

Purpose Ethanol as an excipient is used to enhance the solubility of gemcitabine, but, sometimes, the dose of ethanol a patient may be given is much higher than the dose considered to be toxic. We aimed to assess ethanol-related symptoms and signs in patients receiving two formulations of gemcitabine, with and without ethanol. Methods A randomized double blind cross-over study was conducted. All patients being treated with gemcitabine received two consecutive doses of the drug, one diluted from a concentrate for solution for infusion (CSI) containing ethanol and the other from a lyophilized powder, without ethanol, which was used as control group. After each administration, patients were surveyed in order to assess the appearance of any alcohol consumption symptoms (dizziness, difficulty speaking, unsteady walking, impaired balance, mood swings and slower reactions). Widmark formula and the amount of alcohol measured on the breath (breathalyzer) were used to estimate blood alcohol concentration. Results Twenty-four patients received both formulations and were included in the analysis. Mean administered ethanol dose when prepared from CSI was 15.81 ± 2.25 g (mean ± SD). When using CSI gemcitabine, estimated blood ethanol concentration was 0.033 g/dl according to Widmark formula and 0.02 g/dl according to breathalyzer results. Although overall incidence of symptoms was higher in the study group, the difference was not statistically significant (33% vs. 25%; p = 0.53). Conclusions These findings prove there is no difference in the onset of ethanol related symptoms when using CSI instead of lyophilized powder on the reconstitution of gemcitabine.

Utility of day 8 blood tests on platinum plus vinorelbine regimen

Background The combination of cisplatin or carboplatin with vinorelbine is one of the standard regimens in non-small-cell lung cancer. Some studies have shown that the hemogram on day-8 could be avoided in patients with cisplatin. However, carboplatin had not been studied and is considered to be more myelotoxic than cisplatin. Objective To quantify the incidence of thrombocytopenia, anemia, neutropenia and impaired liver and renal tests on day 8 in patients receiving a doublet protocol including a platinum and vinorelbine. Method The incidence of blood test abnormalities has been quantified in all patients who had received at least one course of cisplatin or carboplatin plus vinorelbine from January 14-December 14. Results Eighty-nine patients and 314 courses on day-8 were evaluated. Moderate or severe hematological toxicity was observed in 5.7 % courses. Dose was skipped in 1.3 % courses related to neutropenia. Renal and liver impairment were not shown. Delayed and reduced doses and early discontinued treatment on day-8 were not caused by blood test abnormalities. Conclusions Blood tests might be spared on day-8 depending on the individual characteristics, above all in patients with carboplatin.