Cancer-Chemotherapy-Related Regimen Checks Performed by Pharmacists of General Hospitals Other than Cancer Treatment Collaborative Base Hospitals: A Multicenter, Prospective Survey.

Although prescription review is an important role for pharmacists in anticancer drug therapy, there are no guidelines in Japan that specify what pharmacists should check for in chemotherapy regimens. This prospective multicenter survey aimed to investigate the implementation of chemotherapy regimen checks by pharmacists in general hospitals by focusing on 19 recommended confirmation items designed to enhance chemotherapy safety. This study involved 14 hospitals within the National Hospital Organization in different regions of Japan. The top five cancers in Japan (gastric, colorectal, lung, breast, and gynecological) were targeted and specific chemotherapy regimens were analyzed. This study assessed the amount of time required for regimen checks, the number of confirmation items completed, the number and the content of inquiries raised regarding prescriptions, and the pharmacists' opinions using a questionnaire that had a maximum score of 10 points. Pharmacists checked 345 and 375 chemotherapies of patients in the control group (CG) and recommended items group (RIG), respectively. The mean time periods required for completing a chemotherapy regimen check were 4 min and 14 s (SD ±1 min and 50 s) and 6 min and 18 s (SD, ±1 min and 7 s) in the CG and RIG, respectively. The mean of the recommended items for the CG = 12.4 and for the RIG = 18.6. The items that the pharmacists did not confirm included urine protein (sixty-nine cases, 18.4%), allergy history (four cases, 1%), previous history (two cases, 0.5%), and a previous history of hepatitis B virus (sixty-nine cases, 18.4%). The number of inquiries for a doctor's prescription order was higher in the RIG than in the CG (41 vs. 27 cases). This multicenter survey demonstrated the potential effectiveness of implementing 19 recommended confirmation items in the regimen checks by pharmacists in general hospitals other than cancer treatment collaborative base hospitals.

Risk Factors Associated with Cisplatin-Induced Nephrotoxicity in Patients with Advanced Lung Cancer.

Cisplatin (CDDP) combination chemotherapy is widely administered to patients with advanced lung cancer. The dose depends on multiple factors, including whether the tumor is non-small-cell lung cancer (NSCLC) or small-cell lung cancer (SCLC). Although efficacy is limited by cisplatin-induced nephrotoxicity (CIN), little is known about the risk factors for this complication. The aim of this study was to identify the risk factors for CIN in patients with advanced lung cancer, both NSCLC and SCLC. We retrospectively reviewed clinical data for 148 patients who underwent initial chemotherapy including CDDP ≥50 mg/m2 per patient per day for the first course at Kyushu Medical Center between October 2010 and September 2013. All data were collected from the electronic medical record system. Nephrotoxicity was defined as an increase in serum creatinine concentration of at least grade 2 during the first course of CDDP chemotherapy, as described by the National Cancer Institute Common Terminology Criteria for Adverse Events version 4.0. CIN was observed in nine patients. Univariate analysis revealed that cardiac disease and lower baseline serum albumin (Alb) values conferred a higher risk of nephrotoxicity (p<0.05). The cut-off value of Alb was 3.8 g/dL, calculated by receiver operating characteristics (ROC) curves. Multivariable logistic regression analysis revealed that cardiac disease (odds ratio=11.7; p=0.002) and hypoalbuminemia (odds ratio=6.99 p=0.025 significantly correlated with nephrotoxicity. In conclusion, cardiac disease and low baseline Alb values are possible risk factors for CIN.

[Risk factors for hyperammonemia during mFOLFOX6 treatment].

Patients undergoing mFOLFOX6 treatment were classified into a hyperammonemia group (NH3 group) or a non-hyperammonemia group (Non-NH3 group) in order to investigate risk factors related to the onset of hyperammonemia. The NH3 group demonstrated significantly lower lymphocyte counts, hemoglobin and albumin levels, and estimated glomerular filtration rates compared to the Non-NH3 group, suggesting that the NH3 group was experiencing renal dysfunction and loss of skeletal muscle mass due to malnutrition. Amino acid fractionation in the NH3 group revealed high urea levels, and delayed urea excretion was identified. Fluorocitric acid, a fluorouracil metabolite, inhibits aconitase in the tricarboxylic acid cycle. In addition, decreased renal urea transporter function due to renal impairment leads to delayed urea excretion. These factors may induce secondary decreases in urea cycle function, leading to hyperammonemia.

Pharmacokinetics and elimination efficiency of linezolid during dialysis.

Linezolid (LZD) is an option for treating infections caused by multi-resistant Gram-positive bacteria. The protein-binding rate of LZD markedly influences its elimination by dialysis, with limited data suggesting that LZD is cleared by intermittent hemodialysis. Here, we investigated the protein-binding rate and elimination efficiency of LZD in a sepsis patient receiving dialysis. The oral administration of LZD at 600 mg/day resulted in protein-binding and free rates of the drug of 20.4% and 79.6%, respectively, 24 h after administration. By comparing the LZD concentration before and after dialysis, the elimination efficiency of free LZD as a result of dialysis was found to be 40.6%. Our sepsis patient showed higher plasma concentrations of LZD at trough after hemodialysis than the reported concentrations in normal renal function patients. However, it is not clear from our present findings if a relationship exists between myelosuppression and plasma LZD concentration.

Pharmacokinetics and administration method of gentamicin in a patient on haemodialysis.

We investigated the pharmacokinetics of gentamicin in a haemodialysis patient treated for endocarditis caused by methicillin-resistant Staphylococcus aureus and found that the administration of gentamicin immediately prior to dialysis was a suitable strategy for reaching target maximum drug concentration (Cmax) values and low trough levels.

Correlation between serum linezolid concentration and the development of thrombocytopenia.

We evaluated the possible association between trough linezolid (LZD) concentrations and platelet counts using a dose-response curve with a logit model equation. We demonstrated that trough LZD concentrations correlated with platelet counts. A significant decrease in platelet count was observed in patients with trough LZD concentrations higher than 22.1 µg/ml.

Pharmacokinetics of carboplatin in a hemodialysis patient with small-cell lung cancer.

PURPOSE: We examined a method to determine the dose of carboplatin and the timing of hemodialysis in carboplatin-based chemotherapy for a hemodialysis patient with cancer. METHODS: Carboplatin-based chemotherapy was performed for a patient with small-cell lung cancer who was receiving hemodialysis. The dose of carboplatin was calculated based on body surface area in the first cycle (480 mg/body, Day 1) and based on the Calvert formula with the aim of achieving AUC of 5 mg/ml min in the second cycle (170 mg/body, Day 1). Carboplatin was continuously infused for 1 h on Day 1 of each cycle. Hemodialysis was performed for 4 h beginning 1 h after administration of carboplatin. RESULTS: The AUC of free carboplatin administered in the first and second cycles was 13.45 and 5.74 mg/ml min, respectively, and t (1/2) was 24.66 and 21.84 h, respectively. Protein binding ratio depended on the time after administration and reached a value ≥50% only at ≥24 h administration. CONCLUSION: Based on the results of this study, a value close to the targeted AUC can be obtained in a hemodialysis patient with cancer when carboplatin is administered at a dose determined based on the Calvert formula. These results may be useful to achieve a targeted AUC in hemodialysis patients. A certain amount of carboplatin can be eliminated by performing hemodialysis in an early phase when protein binding ratio is low after transition to the elimination phase to enable stable the concentration.

[Factor analysis of outcomes during drug-resistant bacterial infection treatment].

Factors related to poor outcome in drug-resistant bacterial infection treatment were analyzed based on surveys at 54 National Hospital Organization facilities. Results showed common etiological causes of Methicillin-resistant Staphylococcus aureus (MRSA) and Penicillin-resistant Streptococcus pneumoniae (PRSP). Specifically, the odds ratio in the elderly, aged 75 years and older, was 1.473 (p=0.006) for MRSA and 6.401 (p=0.0001) for PRSP. Among those undergoing tracheal intubation, the odds ratio was 1.767 (p=0.021) for MRSA and 4.185 (p=0.0001) for PRSP, showing that advanced age and tracheal intubation tended to aggravate disease. MRSA-specific causes were pneumonia with an odds ratio of 2.426 (p=0.0001) and sepsis with one of 1.417 (p=0.013). Causes specific to Multi-drug resistant Pseudomonas aeruginosa (MDRP) were Intravenous hyperalimentation (IVH) with an odds ratio of 2.078 (p=0.0001) and urinary-tract infection with one of 0.566 (p=0.027). The individual roles of these factors in poor outcomes must thus be clarified to develop preventive measures against them.

[Protective effects of d-chlorpheniramine maleate pre-treatment against acute side effects of Irinotecan(CPT- 11)].

It is wellknown that cholinomimetic side effects, such as sedation, abdominal pain, nasal flow and watery eyes, may develop in patients in the early stage of Irinotecan (CPT-11) administration; however, there have been no investigations concerning methods for preventing the development of these side effects. To assess the protective effects of pre-treatment with d-CM on cholinomimetic side effects in the early stage after Irinotecan (CPT-11) administration, we prescribed d- Chlorpheniramine maleate (d-CM) to a group of patients prior to Irinotecan (CPT-11) administration. Twenty members from the group of non-d-CM-treated patients (n=39) and 4 members from the group of treated patients (n=20) complained of side effects. The pre-administration of d-CM significantly reduced the number of patients with side effects (p<0.05). The relative risk (RR) for the frequency of side effects was 0.39 (95% CI; 0.15-0.98), demonstrating that the frequency of side effects was significantly reduced. Based on theses findings, we concluded that the pre-administration of d-CM had protective effects against side effects that might develop in the early stage after Irinotecan (CPT-11) administration.

Altered chain-length and glycosylation modify the pharmacokinetics of human serum albumin.

Human serum albumin with modified plasma half-life will be useful for clinical purposes. Therefore, the pharmacokinetics of three of each of the following types of genetic variants, and of their corresponding normal albumin, were examined in mice: N-terminally elongated, C-terminally truncated and glycosylated albumins. Isoforms differing from the normal protein by three or more amino acids, especially two of the truncated forms, had shorter half-lives. The effect of glycosylation depended on the position of attachment: in domain II it increased half-life, whereas in domain I and III it had no significant effect. Liver, kidney and spleen uptake clearances were also modified. The pronounced changes in half-life of the two truncated variants and the glycosylated isoform could be explained, at least partly, by large changes in organ uptakes; in the remaining six cases, different effects were registered. Such information should be useful when designing therapeutical albumin products for, e.g., drug delivery systems. In addition to various types of cell endocytosis, leading to intracellular destruction or recycling of the proteins, the metabolism of the alloalbumins could be affected by plasma enzymes. No correlation was found between mutation-induced changes in the pharmacokinetic parameters and changes in alpha-helical content or changes in heat stability as represented by DeltaH(v).

Changes of net charge and alpha-helical content affect the pharmacokinetic properties of human serum albumin.

The pharmacokinetics of 17 genetic variants of human serum albumin with single-residue mutations and their corresponding normal albumin were studied in mice. In all cases, the plasma half-life was affected, but only variants with +2 changes in charge prolonged it, whereas changes in hydrophobicity decreased it. Good positive and negative correlations were found between changes in alpha-helical content taking place in domains I+III and domain II, respectively, and changes in half-lives. No correlation was found to type of mutation or to changes in heat stability as represented by DeltaH(v). Liver and kidney uptake clearances were also modified: alpha-helical changes of domains I+III showed good negative correlations to both types of clearances, whereas changes in domain II only had a good positive correlation to kidney uptake clearance. No correlation between the other molecular changes and organ uptakes was observed. The relatively few correlations between changes in molecular characteristics and the organ uptakes of the variants are most probably due to different handling by plasma enzyme(s) and the various types of cell endocytosis. Of the latter, most lead to destruction of albumin, but at least one results in recycling of the protein. The present information should be useful when designing recombinant, therapeutical albumins or albumin products with a modified plasma half-life.

The structural and pharmacokinetic properties of oxidized human serum albumin, advanced oxidation protein products (AOPP).

To determine the pharmacokinetic properties of advanced oxidation protein products (AOPP), we prepared oxidized human serum albumin (oxi-HSA) using chloramine-T (a hypochlorite analogue) in vitro. The AOPP and dityrosine content of oxi-HSA (AOPP content, 244.3+/-12.3 microM; dityrosine content, 0.7+/-0.11 nmol of dityrosine/mg protein) were similar to those of uremic patients. In structural analysis, the increases in AOPP and dityrosine content of HSA induced slight decreases in its alpha-helical content. In pharmacokinetic analysis, oxi-HSA left the circulation rapidly, and organ distribution of oxi-HSA 30 min after intravenous injection was 51% for the liver, 23% for the spleen, and 9% for the kidney, suggesting that the liver and spleen were the main routes of plasma clearance of oxi-HSA. The liver and spleen uptake clearance of oxi-HSA were significantly greater than those of normal HSA (CLliver, 5058+/-341.6 vs 24+/-4.2 microL/hr [p<0.01]; CLspleen, 2118+/-322.1 vs 32+/-2.7 microL/hr [p<0.01]). However, uptake by other organs was not significantly affected by oxidation. These results suggest that the liver and spleen play important roles in elimination of AOPP.