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Environmental Compliance and Control for Radiopharmaceutical Production
Published in Michael Ljungberg, Handbook of Nuclear Medicine and Molecular Imaging for Physicists, 2022
Ching-Hung Chiu, Ya-Yao Huang, Wen-Yi Chang, Jacek Koziorowski
First, the hot lab including the cyclotron room is generally required to be under pressure compared with the outer world, and such an air pressure regime favours both the microbiological quality of the drug product and the radiation safety of the workers. However, an earlier study [27] showed that individuals are the most common contamination source of cytotoxic agents, and pressure differences of manufacturing (or preparation) environment still cannot control this potential risk. On the other hand, a regular air pressure cascade with only overpressurized rooms is preferable for a GMP-compliant regime with overpressurized and underpressurized rooms. Generally, an acceptable and economically compromised solution between GMP- and radiation-based thinking is that the hot lab is operated at atmospheric pressure appropriately ventilated with HEPA filtered air, with overpressurized airlocks, but the cyclotron room is maintained underpressurized. However, when volatile hazardous radioactive substances are involved in radiopharmaceutical preparation (e.g. radioactive iodine-labelled radiopharmaceuticals), an above air pressure regime may not be applicable [26].
Neoplasia in pregnancy
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
In general, several principles can help guide the management of ovarian malignancies in pregnancy. Hysterectomy should be performed during pregnancy only if it contributes significantly to tumor debulking (116,149) and overall prognosis. Additionally, chemotherapy is contraindicated in the first trimester due to high rate of abortion (150) and abnormal fetal development (151), but it is compatible in the second or third trimester (150,152). Platinum-based chemotherapy regimens have the most scientific data supporting their safe use in pregnancy (153). An interval of 3 to 4 weeks between the last chemotherapy administration and the delivery is optimal due to both maternal and fetal hematologic risks from treatment (3). The majority of adverse fetal outcomes are likely due to prematurity with few reports of congenital anomalies (150,154,155). In the postpartum period, breast-feeding should be discouraged while receiving cytotoxic agents (156,157). As always, treatment strategy must be case dependent, and the patient must remain fully informed at all times.
Nucleic Acids as Therapeutic Targets and Agents
Published in David E. Thurston, Ilona Pysz, Chemistry and Pharmacology of Anticancer Drugs, 2021
Bone marrow suppression is the most problematic side effect associated with melphalan and leads to a decreased white blood cell count with increased risk of infection. The resulting decreased platelet count can also increase the risk of bleeding. As with most cytotoxic agents, other common side effects include GI symptoms such as nausea, vomiting, and oral ulceration. Less common side effects include severe allergic reactions, cardiac arrest, interstitial pneumonitis and pulmonary fibrosis (which scars the lung tissue and can be fatal after prolonged use), hair loss, and skin reactions (e.g., rash and itching). Dosing must be reduced in the case of renal impairment, and melphalan should be avoided in breastfeeding. Contraception should be used in both men and women during treatment.
Self-nanoemulsifying drug delivery systems (SNEDDS) of anti-cancer drugs: a multifaceted nanoplatform for the enhancement of oral bioavailability
Published in Drug Development and Industrial Pharmacy, 2023
Eesha Shukla, Divya Dhatri Kara, Tanvi Katikala, Mahalaxmi Rathnanand
Cancer is a non-contagious disease that leads to the uninhibited reproduction of abnormal cells. In the year 2020, WHO reported that cancer caused close to 10 million deaths across the globe. This made it one of the leading illnesses to result in loss of life [1]. A wide variety of treatment options for cancer are available that include Radiation Therapy, Surgery, Hormone Therapy, Photodynamic Therapy, Targeted Therapy, Hyperthermia, Stem Cell Transplant, and Chemotherapy [2]. Drugs used in chemotherapy are broadly classified as cytotoxic, hormonal, and biological agents. Conventional cancer therapy involves cytotoxic agents which terminate cell division by obstructing either DNA or its precursors [3]. The majority of anti-cancer drugs are given through the I.V route as it is direct and does not cause problems such as variable absorption and inadequate bioavailability. This route, however, can be unsafe as it releases a high concentration of drugs in healthy cells [4]. Additionally, it requires visits to hospitals, palliative care, nursing and is troublesome for patients. Long-term delivery via this route has caused infections, hemorrhage, bleeding, and venous thrombosis [5]. Oral therapy proves as a good substitute for IV therapy because of ease of delivery, higher patient compliance, and no requirements of hospital visits or infusion equipment [6].
Can we rely on synthetic pharmacotherapy for the treatment of glioblastoma?
Published in Expert Opinion on Pharmacotherapy, 2021
Chibueze D. Nwagwu, David C. Adamson
There are numerous groups of agents being studied for the treatment of newly diagnosed and recurrent glioblastoma patients. The major outcome measures utilized in these trials include safety/tolerability, maximum tolerated dose (MTD), objective response rate (assessment of tumor burden), median progression-free survival or at 6 months (PFS6), and median overall survival (OS). Here, we focus on synthetic agents currently under investigation. The superseding sections have been stratified according to similarities in mechanisms of action (MoA). The synthetic agents highlighted in this study are either small-molecule inhibitors or cytotoxic agents. Some of these agents have been specifically engineered for the treatment of glioblastoma, while others have been repurposed due to perceived efficacy in preclinical glioblastoma models. Further details regarding these trials may be found in the accompanying table (Table 1).
Secondary chronic myeloid leukemia following acute myeloid leukemia treated with autologous hematopoietic stem cell transplantation: a case report
Published in Current Medical Research and Opinion, 2020
Jing Cheng, Yaping Liao, Ting Bin, Juan OUYang, Shaoqian Chen, Xueyan Chen, Waiyi Zou
Exposure to radiotherapy, chemotherapy, and immunosuppression, either disease or treatment-related, have been suggested as risk factors for secondary malignancies5,22. Xiaohua et al.19 described a patient diagnosed as having AML initially. Symptoms were alleviated after treated with alternate regimens of IA (idarubicin, cytosine arabinoside) and HA (homoharringtonine, cytosine arabinoside). The patient remained in continuous complete remission for 62 months; after that, he was found to have leukocytosis and was finally confirmed as having Ph-positive CML. Cytotoxic agents for patients are considered to play a crucial role in the development of secondary malignancies. Chemotherapy, such as the MAE program, cannot be ruled out as the possible cause of secondary malignancies, although there are no relevant reports.