Cass Yaakov, Connor Thomas H, Tabachnik Alexander
1 Israel Ministry of Health, Ramla, Israel.
2 Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Cincinnati, OH, USA.
J Oncol Pharm Pract. 2017 Jul;23(5):350-378. doi: 10.1177/1078155216637217. Epub 2016 Mar 22.
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.
引言 随着越来越多的口服靶向疗法被批准用于癌症治疗，长期给癌症患者使用这些药物的可能性正在扩大。在家庭环境中使用这些药物有可能使家庭成员和护理人员通过直接接触药物，或间接接触受污染患者排泄物中的母体化合物和/或其活性代谢物而接触到这些药物。方法 进行了系统的文献综述，并总结了32种口服靶向疗法已知的不良健康影响。特别评估了致癌性、遗传毒性和胚胎-胎儿毒性以及排泄途径。结果 大多数口服靶向疗法尚未进行致癌性测试，遗传毒性数据也不一致。然而，这些药物中的大多数都表现出不良生殖影响，其中一些影响较为严重。目前，现有数据不允许忽视因不当处理药物和受污染患者排泄物而产生健康危害的可能性，尤其是在长期家庭环境中。需要进一步研究来了解这些问题。结论 随着靶向疗法在家庭环境中的使用不断增加，家庭成员和护理人员，尤其是处于生殖风险年龄的人员，有可能面临风险。应采取全面的基础教育和相关预防措施，以保护家庭成员和护理人员免受这些药物的间接或直接接触。对此主题进行进一步调查和讨论是必要的。
