Securing the circuit of intrathecally administered cancer drugs: example of a collective approach

Abstract

The treatment of leptomeningeal metastasis is based on protocols linking systemic chemotherapies and intrathecal injections of antineoplastic agents. Since the late 1960s, cases of accidental intrathecal injections of vinca-alkaloids, which have almost always proved fatal, have been documented. The most concerned countries, supported by the WHO, have published numerous recommendations aimed at reducing this type of risk. The aim of our work was to improve safety procedures for the intrathecal administration of antineoplastic drugs in an oncology hospital: the Centre Oscar Lambret, Lille, France. To this end, we compiled and analyzed a total of eight international recommendations. Our method was to meet the requirements of the AFSSAPS (French agency for the safety of health products), then to adopt recommended procedures in other countries, where appropriate. We considered the whole drugs circuit from prescription to administration. Improvements basically focused on the computerization of prescription, the dilution in mini-bags of vinca-alkaloids, and the additional labeling of intrathecally administered preparations as well as those with some vinca-alkaloids. This multidisciplinary approach to improve our practices complements the precautions taken by healthcare teams.