Targeted therapies represent emerging and evolving classes of drugs. There is limited data on the effects of these agents and their potential occupational health risks, so further hazard assessments are required.9, 12 Most biological agents do not affect DNA and therefore do not cause genetic changes. One agent that is considered a hazardous agent is interferon.26
Australian consensus guidelines were developed in 2014 to address uncertainty and variation of practice relating to the handling of monoclonal antibodies for cancer. Recommendations have been made for the minimum safe handling requirements to protect all health care personnel. Safe handling recommendations are based on risk assessment of individual agents. The use of interventions / safeguards to minimise occupational exposure should be risk stratified according to risk of internal exposure and toxicity.27
SCNs involved in administering these agents need to ensure local policy and procedures relevant to these agents are updated in light of current evidence, and promote safe practice.
Biopharmaceuticals are inherently different to other drugs and the following principles guiding their storage, preparation, and handling should be followed:9, 10
- biopharmaceuticals are protein-based agents and refrigeration is often required
- biopharmaceuticals cannot tolerate extremes in temperature when transported such as car boots and aeroplane baggage holds
- use safe handling precautions for biopharmaceuticals that are considered hazardous (e.g. IFN)
- wear gloves when biopharmaceuticals are irritating to the skin (e.g. rituximab)
- when lyophilised product is reconstituted the vial should not be shaken, and the solution should be directed down the side of the vial and not onto powder
- do not shake as this may cause foaming and can denature the protein
- not all biopharmaceuticals are compatible with all plastic syringes and intravenous tubing.
The SCN needs to be familiar with the agents being administered and provide information to individuals on drug interactions.The oral TKI imatinib and the second generation agents dasatinib and nilotinib are all metabolised via the P450 microenzyme CYP3A4.25, 28 Co-administration of certain drugs may increase or decrease the metabolism of these agents. Individuals taking imatinib should be informed of the need to avoid grapefruit products and alcohol due to the increased risk of liver toxicity and P450 interactions.28
Access the following resources:
- Local policy, procedures and/or clinical guidelines related to safe handling
- Australian consensus guidelines for the safe handling of monoclonal antibodies for cancer treatment by healthcare personnel(PDF, 1MB). 201427
- Preventing occupational exposure to antineoplastic and other hazardous drugs in health care settings. National Institute for Occupational Safety and Health. (2004).26
Discuss the major considerations that designate a drug as hazardous.
Access the web resources listed and identify those targeted therapies currently classified as hazardous drugs.
Discuss the extent to which current local policies and procedures are consistent with the principles of safe handling and administration of targeted therapies.
Identify strategies you would use in an oncology setting to ensure practice is consistent with the principles of safe handling and administration of targeted therapies.
Access Herb-Drug Interactions in Oncology: Focus on Mechanisms of Induction29 and Drug Interactions with Newer Oral Chemotherapy Agents30, and discuss the implications of herb / drug interactions identified in five agents used in your health care setting.