Avoiding Carcinogen Exposure With Intraperitoneal Paclitaxel

Oswald A. Stuart

Claudette Knight

Paul H. Sugarbaker

ONF 2005, 32(1), 44-48. DOI: 10.1188/05.ONF.44-48

Purpose/Objectives: Diethylhexylphthalate (DEHP) is a lipid-soluble plasticizer commonly used in the manufacture of polyvinyl chloride-(PVC-) based plastics. Previous studies have documented the leaching of DEHP from PVC-based containers and extension sets during the IV administration of paclitaxel.

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    Autian, J. (1973). Toxicity and health threats of phthalate esters: Review of the literature. Environmental Health Perspectives, 4, 3-26.

    Barry, Y.A., Labow, R.S., Rock, G., & Keon, W.J. (1988). Cardiotoxic effects of the plasticizer metabolite, mono(2-ethlyhexyl)phthalate (MEHP), on human myocardium. Blood, 72, 1438-1439.

    Bedford Laboratories (2001). Paclitaxel injection [Package insert]. Bedford, OH: Author.

    de Bree, E., Rosing, H., Beijnen, J.H., Romanos, J., Michalakis, J., Georgoulias, V., et al. (2003). Pharmacokinetic study of docetaxel in intraoperative hyperthermic i.p. chemotherapy for ovarian cancer. Anti-Cancer Drugs, 14, 103-110.

    Doull, J., Cattley, R., Elcombe, C., Lake, B.G., Swenberg, J., Wilkinson, C., et al. (1999). A cancer risk assessment of di(2-ethylhexyl)phthalate: Application of the new U.S. EPA Risk Assessment Guidelines. Regulatory Toxicology and Pharmacology, 29, 327-357.

    Feldman, A.L., Libutti, S.K., Pingpank, J.F., Bartlett, D.L., Beresnev, T.H., Mavroukakis, S.M., et al. (2003). Analysis of factors associated with outcome in patients with malignant peritoneal mesothelioma undergoing surgical debulking and intraperitoneal chemotherapy. Journal of Clinical Oncology, 21, 4560-4567.

    Gray, T.J., Beamand, J.A., Lake, B.G., Foster, J.R., & Gangolli, S.D. (1982). Peroxisome proliferation in cultured rat hepatocytes produced by clofibrate and phthalate ester metabolites. Toxicology Letters, 10, 273-279.

    Kevy, S.V., & Jacobson, M.S. (1982). Hepatic effects of a phthalate ester plasticizer leached from poly vinyl chloride blood bags following transfusion. Environmental Health Perspectives, 45, 57-64.

    Maas, B., Huber, C., & Kramer, I. (1996). Plasticizer extraction of Taxol infusion solution from various infusion devices. Pharmacy World and Science, 18(2), 78-82.

    Markman, M., Rowinsky, E., Hakes, T., Reichman, B., Jones, W., Lewis, J.L., Jr., et al. (1992). Phase I trial of intraperitoneal Taxol: A Gynecologic Oncology Group study. Journal of Clinical Oncology, 10, 1485-1491.

    Mazur, H.I., Stennett, D.J., & Egging, P.J. (1989). Extraction of diethylhexylphthalate from total nutrient solution-containing polyvinyl chloride bags. Journal of Parenteral and Enteral Nutrition, 13, 59-62.

    Mazzo, D.J., Nguyen-Huu, J.J., Pagniez, S., & Denis, P. (1997). Compatibility of docetaxel and paclitaxel in intravenous solutions with polyvinyl chloride infusion materials. American Journal of Health-System Pharmacy, 54, 566-569.

    Mohamed, F., Marchettini, P., Stuart, O.A., Yoo, D., & Sugarbaker, P.H. (2003). A comparison of hetastarch and peritoneal dialysis solution for intraperitoneal chemotherapy delivery. European Journal of Surgical Oncology, 29, 261-265.

    Rock, G., Labow, R.S., Franklin, C., Burnett, R., & Tocchi, M. (1987). Hypotension and cardiac arrest in rats following infusion of mono(2-ethylhexyl)-phthalate (MEHP), a contaminant of stored blood. New England Journal of Medicine, 316, 1218-1219.

    Sadeghi, B., Arvieux, C., Glehen, O., Beaujard, A.C., Rivoire, M., Baulieux, J., et al. (2000). Peritoneal carcinomatosis from non-gynecologic malignancies. Results of the EVOCAPE 1 multicentric prospective study. Cancer, 88, 358-363.

    Singh, A.R., Lawrence, W.H., & Autian, J. (1972). Teratogenicity of phthalate esters in rats. Journal of Pharmaceutical Sciences, 61, 51-55.

    Sugarbaker, P.H., Acherman, Y.I.Z., Gonzalez-Moreno, S., Ortega-Perez, G., Stuart, O.A., Marchettini, P., et al. (2002). Diagnosis and treatment of peritoneal mesothelioma: The Washington Cancer Institute experience. Seminars in Oncology, 29, 51-61.

    Trissel, L.A., Xu, Q., Kwan, J., & Martinez, J.F. (1994). Compatibility of paclitaxel injection vehicle with intravenous administration and extension sets. American Journal of Hospital Pharmacy, 51, 2804-2810.

    U.S. Environmental Protection Agency. (1999). Integrated Risk Information System (IRIS) on Di(2-ethylhexyl)phthalate. Washington, DC: National Center for Environmental Assessment, Office of Research and Development.

    Warren, J.R., Lalwani, N.D., & Ready, J.K. (1982). Phthalate esters as peroxisome proliferator carcinogens. Environmental Health Perspectives, 45, 35-40.

    Waugh, W.N., Trissel, L.A., & Stella, V.J. (1991). Stability, compatibility, and plasticizer extraction of taxol (NSC-125973) injection diluted in infusion solutions and stored in various containers. American Journal of Hospital Pharmacy, 48, 1520-1524.

    Yonemura, Y., Bandou, E., Sawa, T., Yoshimitsu, Y., Endou, Y., Sasaki, T., et al. (2004). Phase II study of neoadjuvant intraperitoneal-systemic chemotherapy plus gastrectomy with peritonectomy for gastric cancer with peritoneal dissemination. Manuscript submitted for publication.