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Methotrexate is an important immunosuppressive and antineoplastic drug and is widely used for treatment. However, hepatotoxicity is one of the major adverse effects of methotrexate. In this study, it was aimed to investigate whether ramelteon has a possible protective effect on hepatotoxicity induced by methotrexate. Thirty-two Wistar albino rats were equally divided into four groups: control, methotrexate, methotrexate + ramelteon, and ramelteon. Following a single dose of 20 mg/kg, methotrexate (i.p.), either saline or ramelteon 10 mg/kg (orally) was administered for 7 days. After treatment, animals were sacrificed, and histopathological analyses were evaluated with Hematoxylin-eosin (H-E), immunohistological analyses were evaluated with Interleukin-1 Beta (IL-1 beta) and Caspase 3 (CAS-3), biochemical analyzes were evaluated with Total Oxidant Status (TOS), Total antioxidants status (TAS), Oxidative Stress Index (OSI), aspartate aminotransferase (AST), alanine aminotransferase (ALT) activities, at last genetical analyses were evaluated with Sirtuin-1 (SIRT-1) - P53 gene expressions. In the control and ramelteon groups, normal histological structures were observed, while histopathological findings were observed in the methotrexate group. Increasing levels of IL-1 beta staining, CAS-3 staining, p53 gene expression, TOS, OSI, AST and ALT were observed in methotrexate group while were observed decreasing levels of TAS and SIRT-1 gene expression (p < 0.05). However, ramelteon reduced the increased findings in methotrexate-induced hepatotoxicity (p < 0.05). The results of the present study showed that ramelteon protects against methotrexate induced hepatotoxicity in rats via SIRT-1 signaling by histological, immunohistological, biochemical and genetical analyses.

Background The Japanese Pharmaceuticals and Medical Devices Agency (PMDA) was established in 2004. Since then, various pieces of legislation, notices, and guidelines have been issued, and the regulatory approval pathways for domestic drugs have been diversified. However, the effects of these measures have not been fully examined. We examined the impact of these measures on the approval of antineoplastic drugs and the design of pivotal clinical trials for efficacy assessment by the PMDA. Methods We collected data on the antineoplastic drugs approved by the PMDA in fiscal years 2004–2019. We extracted the approval review pathways and the pivotal clinical trial designs from the PMDA review reports, and analyzed them to identify patterns. Results In total, 387 indications in oncology were approved by the PMDA in fiscal years 2004–2019, or 365 indications excluding multiple regulatory pathways. The number of approved indications generally increased year on year (p

Background Caregivers in healthcare settings are exposed to a risk of antineoplastic drug contamination which can lead to adverse health effects. Biological monitoring is necessary to estimate the actual level of exposure of these workers. This study was conducted with the aim of assessing blood contamination levels by irinotecan and its metabolites of pharmaceutical staff operating inside and outside a compounding unit. Methods The study took place within the pharmaceutical unit of a French comprehensive cancer centre. Blood samples were collected from the pharmacy workers operating inside and outside the compounding unit, and analysed by UHPLC-MS/MS. Plasma and red blood cell irinotecan and its metabolites (SN-38; APC) were determined with a validated analytical method detection test. Results A total of 17/78 (21.8%) plasma and red blood cell-based assays were found to be contaminated among staff. Overall, the total number of positive assays was significantly higher for staff members working outside the compounding unit than for workers working inside it ( P = 0.022), with respectively 5/42 (11.9%) and 12/36 (33.3%) positive assays. For plasma dosages, the “outside” group had a significantly higher number of positive assays ( P = 0.014). For red blood cell-based assays, no significant difference was found ( P = 0.309). Conclusions This study reveals that pharmaceutical staff serving in health care settings are exposed to a risk of antineoplastic drug contamination, not only inside the compounding room but also in adjacent rooms. The results would help to raise awareness and potentially establish protective measures for caregivers working in areas close to the compounding room as well.

Aim: The aim of our present work was to develop and validate a reverse phase high-performance liquid chromatography (RP-HPLC) method for the simultanious determination of Decitabine (DEC) and Cedazuridine (CED). Methodology: The developed method was further applied to observe the degradation of analytes under the influence of different forced degradation conditions. Analytes were resolved on C18, 250 x 4.6 mm, particle size 5 µm Xterra column, using a mobile phase combination of 0.1% Ortho Phospharic Acid buffer pH 6.5: Methanol (40:60v/v) with flow rate of 1mL/min and injection volume of 10 µL. Quantification was carried out with PDA detector at an isosbestic point of 220 nm with a linear calibration curve in the concentration range of 35-175 μg/mL for DEC and 100-500 μg/mL for CED. Results: Validation of the developed method was performed as per ICH guidelines viz., linearity, accuracy, precision, and robustness. The limits of detection (LOD) and the limits of quantification (LOQ) for CED were found to be 2.69 µg/mL and 8.15 µg/mL respectively. LOD and LOQ for DEC 1.55 µg/mL and 4.68 µg/mL respectively. Moreover, validated method was applied to study the degradation profile of analytes under various stress degradation conditions. Conclusion: The proposed method was found to be sensitive, specific and was successfully applied for the simultaneous estimation of Decitabine (DEC) and Cedazuridine (CED) in bulk drug, and tablets.

Background and Aim. Antineoplastic drug-induced cardiotoxicity (ADIC) becomes the second leading cause of death for tumor survivors after tumor recurrence and metastasis, and there may be great room for development in the future of traditional Chinese medicine (TCM). However, the theory of anticardiotoxicity of TCM has not yet formed a system. This study aimed to explore the material basis and the rule of TCM against ADIC based on network pharmacology and data mining. Methods. The targets of antineoplastic drugs with cardiotoxicity were obtained from the National Center for Biotechnology Information (NCBI) database, China national knowledge infrastructure (CNKI) database, and Swiss Target Prediction platform. Then, the cardiotoxicity-related targets were derived from the Gene Cards, Disgenet, OMIM, and DrugBank databases, as well as the drug of current clinical guidelines. The targets both in these two sets were regarded as potential targets to alleviate ADIC. Then, candidate compounds and herbs were matched via Traditional Chinese Medicine Systems Pharmacology (TCMSP) platform. Cytoscape3.7.1 was used to set up the target-compound-herb network. Molecular docking between core targets and compounds was performed with AutodockVina1.1.2. The rules of herbs were summarized by analyzing their property, flavor, and channel tropism. Results. Twenty-one potential targets, 332 candidate compounds, and 400 kinds of herbs were obtained. Five core targets including potassium voltage-gated channel subfamily H member 2 (KCNH2), cyclin-dependent kinase 1 (CDK1), matrix metalloproteinase 2 (MMP2), mitogen-activated protein kinase1 (MAPK1), and tumor protein p53 (TP53) and 29 core compounds (beta-sitosterol, quercetin, kaempferol, etc.) were collected. Five core herbs (Yanhusuo, Gouteng, Huangbai, Lianqiao, and Gancao) were identified. Also, the TCM against ADIC were mainly bitter and acrid in taste, warm in property, and distributed to the liver and lung meridians. Conclusion. TCM against ADIC has great potential. Our study provides a new method and ideas for clinical applications of integrated Chinese and western medicine in treating ADIC.

Objectives: In the proposed study, a basic, novel, protected economic, delicate and cost-effective UV-Spectrophotometric technique for the analysis of Decitabine which is antineoplastic drug. Methods: The created method was approved according to ICH rules. The decitabine indicated maximum absorption at 221 nm. This strategy can successfully apply for estimation of Decitabine in active pharmaceutical ingredient (API) form for routine examination with UV identification at 221 nm. A Shimadzu UV-Visible spectrophotometer 1800 with 1 cm quartz cells and Acetonitrile (ACN) as diluent was utilized in this technique. Results: The Developed technique obeyed Beer's-Lambert's law in the conc. of 5.0-15.0 ug/ml, having R2 of 0.9993 and 99.82%±0.75 recovery of decitabine was found. Different approval parameters like linearity, accuracy, precision and robustness were performed and were found to be within the limits as per the guidelines of ICH

We report benzeneselenol-modified gold nanoclusters (Se_Au NCs) that have significant anticancer activity by inducing autophagy and disassembly of F-actin in cancer cells. Upon treatment of different tumor models on mice, it has been found that Se_Au NCs exhibit excellent antitumor efficacy, high stability, and extremely low toxicity, which are the requirements for an ideal antineoplastic drug. Our study is a successful attempt in exploring novel anticancer agents with high biosafety.

Antineoplastic drugs are a wide and heterogeneous group of substances that, as universally known, can cause highly severe toxic effects to whoever is exposed. From an occupational safety point of view, surface contaminations inside preparation and administration units are a growing issue and therefore require the development and implementation of sensible and fast monitoring methods. The unlikelihood of a unique all-embracing chromatography, able to correctly retain and separate each analyte led to the need to create an orthogonal normal phase analysis, which might be able to fill the gaps in the more common reversed-phase ones. An existing hydrophilic interaction method has thus been expanded to 6 other drugs and applied to real samples after an evaluation of its performances. The experimental data were then used to evaluate the possibility of estimating reliable relationships between the chromatographic retention and the chemical-structural features of the drugs under analysis.

Zeolites and zeolitic imidazolate frameworks (ZIFs) are widely studied as drug carrying nanoplatforms to enhance the specificity and efficacy of traditional anticancer drugs. At present, there is no other systematic review that assesses the potency of zeolites/ZIFs as anticancer drug carriers. Due to the porous nature and inherent pH-sensitive properties of zeolites/ZIFs, the compounds can entrap and selectively release anticancer drugs into the acidic tumor microenvironment. Therefore, it is valuable to provide a comprehensive overview of available evidence on the topic to identify the benefits of the compound as well as potential gaps in knowledge. The purpose of this study was to evaluate the potential therapeutic applications of zeolites/ZIFs as drug delivery systems delivering doxorubicin (DOX), 5-fluorouracil (5-FU), curcumin, cisplatin, and miR-34a. Following PRISMA guidelines, an exhaustive search of PubMed, Scopus, Embase, and Web of Science was conducted. No language or time limitations were used up to 25th August 2021. Only full text articles were selected that pertained to the usage of zeolites/ZIFs in delivering anticancer drugs. Initially, 1279 studies were identified, of which 572 duplicate records were excluded. After screening for the title, abstract, and full texts, 53 articles remained and were included in the qualitative synthesis. An Inter-Rater Reliability (IRR) test, which included a percent user agreement and reliability percent, was conducted for the 53 articles. The included studies suggest that anticancer drug-incorporated zeolites/ZIFs can be used as alternative treatment options to enhance the efficacy of cancer treatment by mitigating the drawbacks of drugs under conventional treatment.

Cytostatics are toxic pharmaceuticals, whose presence in surfaces puts healthcare workers at risk. These drugs might also end up in hospital effluents (HWW), potentially damaging aquatic ecosystems. Bicalutamide is a cytostatic extensively consumed worldwide, but few analytical methods exist for its quantification and most of them require advanced techniques, such as liquid chromatography mass spectrometry (LC-MS), which are very complex and expensive for large monitoring studies. Therefore, a simple but reliable multi-matrix high performance liquid chromatographic method, with fluorescence detection, was developed and validated to rapidly screen abnormal concentrations of bicalutamide in HWW and relevant contamination levels of bicalutamide in indoor surfaces (&gt, 100 pg/cm2), prior to confirmation by LC-MS. The method presents good linearity and relatively low method detection limits (HWW: 0.14 ng/mL, surfaces: 0.28 pg/cm2). Global uncertainty was below 20% for concentrations higher than 25 ng/mL (HWW) and 50 pg/cm2 (surfaces), global uncertainty was little affected by the matrix. Therefore, a multi-matrix assessment could be achieved with this method, thus contributing to a holistic quantification of bicalutamide along the cytostatic circuit. Bicalutamide was not detected in any of the grab samples from a Portuguese hospital, but an enlarged sampling is required to conclude about its occurrence and exposure risks.

BACKGROUND: Many guidelines and safety measures led to a decrease in exposure to antineoplastic agents. Since healthcare workers are often exposed to lower concentrations than patients, a sensitive method is needed to quantify occupational exposure. OBJECTIVE: The aim of this study was to develop and validate a sensitive method for simultaneous detection and quantification of cyclophosphamide, ifosfamide and paclitaxel in urine by use of UPLC-MS/MS with a UniSpray ionisation source. METHODS: Compounds were extracted from urine using Novum simplified liquid extraction cartridges, separated on a C18 column, ionised by a UniSpray ionisation source and detected with MS/MS. In the second part of the study, a field study was performed to assess occupational exposure to antineoplastic agents. RESULTS: Eighty-three samples from healthcare workers were analysed and resulted in seventeen samples containing quantifiable concentrations of at least one compound. In conclusion, a sensitive method for simultaneous detection and quantification of cyclophosphamide (LLOQ 0.05 ng/mL), ifosfamide (LLOQ 0.3 ng/mL) and paclitaxel (LLOQ 0.7 ng/mL) was developed and validated. ispartof: JOURNAL OF CHROMATOGRAPHY B-ANALYTICAL TECHNOLOGIES IN THE BIOMEDICAL AND LIFE SCIENCES vol:1205 ispartof: location:Netherlands status: published

The interaction of calf thymus DNA (ct DNA) with anastrozole, which is acknowledged as an antineoplastic drug, has been enquired into in the absence and presence of histone H1, through the means of absorbance, fluorescence, circular dichroism spectroscopy, viscosity, thermal melting, and molecular modeling techniques. In addition, the effects of anastrozole on MCF 7 cell line have been thoroughly investigated. Fluorescence spectroscopy results have indicated that quenching mechanism of ct DNA-anastrozole are known as static quenching procedures, since the Stern-Volmer quenching constant (K

Methotrexate (MTX) is an antineoplastic drug widely used in cancer therapies with potentially toxic activity. This paper describes the electrochemical behavior of MTX in ITO (indium tin oxide) electrodes modified with nanostructured films containing biopolymers extracted from babassu mesocarp (BM) (Orbignya phalerata), aiming to develop electrochemical sensors for this drug. After combining PVS (polyvinyl sodium sulfonate) with BM, the analytical sensitivity of the sensor was improved from 2.49 (ITO) to 5.55 μA μmol L−1 (ITO/PVS/BM). The modification of the ITO with the proposed film yielded a detection limit of 5.95 × 10−7 mol L−1 for MTX. The presence of BM in the film considerably increased the sensor roughness as well as the interactions with MTX, which improved the analytical performance of the proposed system. This study demonstrated the possibility of quantifying MTX with electrochemical techniques using natural polymers, which can yield great financial and health benefits.

5-Fluorouracil is an antineoplastic drug with a narrow therapeutic window. Pets are commonly exposed to the cream used for pre-malignant and malignant skin lesions in humans. 5-Fluorouracil poisoning is characterised by severe gastrointestinal (vomiting; diarrhoea; and gastrointestinal ulceration and haemorrhage) and neurological effects (ataxia, tremors and convulsions), and from 4–7 days bone marrow depression. Progression of signs can be rapid and control of neurological effects can be refractory to treatment. There is no specific antidote suitable for companion animals with 5-fluorouracil toxicosis, and aggressive supportive management is required. Filgrastim (a human granulocyte colony stimulating factor) can be used in the management of severe bone marrow depression, but prognosis is generally poor in dogs and cats with pronounced signs from 5-fluorouracil poisoning.

In this work, a multifunctional system was developed in which antibacterial and luminescent properties were inserted into the matrix of hydroxyapatite (HAp) and its efficiency as a support for an antineoplastic drug was evaluated, aiming its application in the treatment of osseous diseases. The precipitation method was used for the synthesis of HAp, EuCl3 was used for the incorporation of Eu3+ as imaging agents, silver nanoparticles (AgNPs) with antimicrobial function were used, and a model of drug, 5-fluorouracil (5FU) was used. The developed material is characterized by several techniques, where crystalline peaks attributed to HAp were identified in the X-ray diffractogram, whereas the luminescence spectrum of the material presented emissions attributed to the Eu3+ ion. The identification and the uniform distribution of AgNPs, 5FU, and Eu3+ were confirmed by mapping the sample using energy-dispersive spectroscopy. The measurements indicated that 82% (±2.8) of 5FU was incorporated into the HAp matrix, and a gradual and increasing release of it as a function of time was observed. Assays carried out for different bacteria confirmed the antimicrobial action of the samples and the efficiency of the drug inserted into the matrix. An in vitro assay showed the bioactivity of the material and its potential to bind to living osseous tissue.

Although considerable efforts have been made over the last 40 years, occupational exposure to antineoplastic drugs is still a daily concern, since eradicating such contamination from workplaces seems unattainable. Considerable data are currently available on the risks associated with their use at work. Hospital facilities are often cleaned with marketed antimicrobials whose chemical decontamination efficacy certainly differs but remains unknown. To keep compounding facilities sterile, alcohol-based solutions are frequently used but with very limited efficiency. It would be particularly useful if a decontamination method could be added to the means already available so that all conventional antineoplastic drug contamination could be removed. Several degradation methods or desorption methods have previously been experimented, with varying success. They have never been compared or discussed in terms either of efficiency or usability. This review aims to analyse and discuss the results of each degradation or decontamination procedure and to compare them. This should facilitate selection of the method to be implemented in daily practice.

Antineoplastic drugs (AD) have been increasingly used, but the disposal of their wastes in the environment via hospital effluent and domestic sewage has emerged as an environmental issue. The current risks posed to these animals and effects of pollutants on the reptiles’ population level remain unknown due to lack of studies on the topic. The aim of the present study was to evaluate the mutagenicity of neonate Podocnemis expansa exposed to environmental concentrations (EC) of cyclophosphamide (Cyc). The adopted doses were EC-I 0.2 μg/L and EC-II 0.5 μg/L Cyc. These doses correspond to 1/10 and ¼ of concentrations previously identified in hospital effluents. Turtles exposed to the CyC recorded larger total number of erythrocyte nuclear abnormalities than the ones in the control group after 48-h exposure. The total number of abnormalities for both groups (EC-I and EC-II) 96 h after the experiment had started was statistically similar to that of animals exposed to high Cyc concentration (positive control 5 × 104 μg/L). This outcome confirms the mutagenic potential of Cyc, even at low concentrations. On the other hand, when the animals were taken to a pollutant-free environment, their mutagenic damages disappeared after 240 h. After such period, their total of abnormalities matched the basal levels recorded for the control group. Therefore, our study is the first evidence of AD mutagenicity in reptiles, even at EC and short-term exposure, as well as of turtles’ recovery capability after the exposure to Cyc.

The automated aseptic preparation of ready-to-administer antineoplastic drug solutions with robotic systems reduces the risk of occupational exposure. However, the surfaces in the preparation area of the robot are to be cleaned by wiping with an appropriate cleaning solution. The aim of the study was to evaluate the cleaning efficacy of four cleaning solutions on four surface materials installed in the APOTECAchemo robot. Predefined amounts of cisplatin (Cis), 5-fluorouracil (5-FU), and cyclophosphamide (CP) were intentionally spread on test plates made of stainless steel, aluminium, polyoxymethylene, and polycarbonate just as installed in the robotic system APOTECAchemo. After drying, the plates were cleaned with 0.2% ethanolic NaOH, 0.23% isopropanolic sodium dodecylsulfate (SDS-2P), 0.5% sodium hypochlorite (NaOCl), and 0.1% benzalkonium chloride (BZK) solutions following a standardized wiping protocol. Residual contamination was recovered with wipe tests, Pt was quantified by voltammetry, and 5-FU and CP was quantified by gas chromatography-tandem mass spectrometry (GC-MSMS). The mean residual contamination after cleaning and the cleaning efficacy (CE) rates were calculated and aggregated on different levels. The CE rates varied between 81.5% and 100% and lay in the majority of cases above 90%. The lowest CE rates were registered for Pt contamination. Especially on aluminium surfaces the residual contamination was high. The overall CE rates of the three different drugs and four different surface types amounted to 98.3% for NaOCl, 97.9% for SDS-2P, 96.9% for ethanolic NaOH, and 96.5% for BZK. The tested cleaning solutions proved to be higher than 90% in most cases, but none of them was able to eliminate 100% of the intentional surface contamination of three antineoplastic drugs on the test plates. The cleaning efficacy varied according to the different surface types and antineoplastic drug. Results could be used in the daily clinical practice to develop and implement effective cleaning procedures.

Rationale. From 2014 to 2017, the portion of antineoplastic drugs dossiers submitted to reimbursement in Russia has grown from 15% to 28%. This group of drugs is characterized by severe adverse events (Aes). The question whether drug safety is taken into consideration by decision makers is still open.Aim: To evaluate the role of drug safety in making the decision on reimbursement.Materials and methods. The data were taken from the reports of expert committees concerning the dossiers submitted between 2014 and 2016. The year of submission, the international drug name, the total safety score and the final decision of the committee were entered into our database. Parametric and non-parametric statistics were used to calculate the difference between the mean safety scores plotted by years and by inclusion/noninclusion into VeD lists.Results. The mean safety score for all drugs of this group was -4,67 (95% CI from -5,04 to -4,29); for the drugs included into VeD lists it was -4,05 (95% CI from -4,68 to -3,42), that was significantly higher (p = 0,01) compared to the non-included medications (-5,03; 95% CI from -5,49 to -4,58). The mean safety scores year-by-year for the non-included drugs were lower than those for the VeD-included drugs, but the difference reached significance only in 2015 (p = 0,01). The safety scores were mainly based on Aes of type A.Conclusion. our analysis shows that the drug safety data play a role in the decision making on reimbursement and inclusion/noninclusion into VeD lists. Yet the total safety score contributes much less than other criteria in the decision making process. The safety analysis is usually based on Aes of type A, whereas the data on Aes of types C and D are insufficient.

Nowadays, enzyme-mediated processes offer an eco-friendly and efficient alternative to the traditional multistep and environmentally harmful chemical processes. Herein we report the enzymatic synthesis of cladribine by a novel 2′-deoxyribosyltransferase (NDT)-based combined biocatalyst. To this end, Lactobacillus delbrueckii NDT (LdNDT) was successfully immobilized through a two-step immobilization methodology, including a covalent immobilization onto glutaraldehyde-activated biomimetic silica nanoparticles followed by biocatalyst entrapment in calcium alginate. The resulting immobilized derivative, SiGPEI 25000-LdNDT-Alg, displayed 98% retained activity and was shown to be active and stable in a broad range of pH (5–9) and temperature (30–60 °C), but also displayed an extremely high reusability (up to 2100 reuses without negligible loss of activity) in the enzymatic production of cladribine. Finally, as a proof of concept, SiGPEI 25000-LdNDT-Alg was successfully employed in the green production of cladribine at mg scale.

Nowadays, enzyme-mediated processes offer an eco-friendly and efficient alternative to the traditional multistep and environmentally harmful chemical processes. Herein we report the enzymatic synthesis of cladribine by a novel 2′-deoxyribosyltransferase (NDT)-based combined biocatalyst. To this end, Lactobacillus delbrueckii NDT (LdNDT) was successfully immobilized through a two-step immobilization methodology, including a covalent immobilization onto glutaraldehyde-activated biomimetic silica nanoparticles followed by biocatalyst entrapment in calcium alginate. The resulting immobilized derivative, SiGPEI 25000-LdNDT-Alg, displayed 98% retained activity and was shown to be active and stable in a broad range of pH (5–9) and temperature (30–60 °C), but also displayed an extremely high reusability (up to 2100 reuses without negligible loss of activity) in the enzymatic production of cladribine. Finally, as a proof of concept, SiGPEI 25000-LdNDT-Alg was successfully employed in the green production of cladribine at mg scale.

Cancer is one of the leading causes of death in the world, and antineoplastic drug research continues to be a major field in medicine development. The marine milieu has thousands of biological species that are a valuable source of novel functional proteins and peptides, which have been used in the treatment of many diseases, including cancer. In contrast with proteins and polypeptides, small peptides (with a molecular weight of less than 1000 Da) have overwhelming advantages, such as preferential and fast absorption, which can decrease the burden on human gastrointestinal function. Besides, these peptides are only connected by a few peptide bonds, and their small molecular weight makes it easy to modify and synthesize them. Specifically, small peptides can deliver nutrients and drugs to cells and tissues in the body. These characteristics make them stand out in relation to targeted drug therapy. Nowadays, the anticancer mechanisms of the small marine peptides are still largely not well understood; however, several marine peptides have been applied in preclinical treatment. This paper highlights the anticancer linear and cyclic small peptides in marine resources and presents a review of peptides and the derivatives and their mechanisms.

Nowadays, enzyme-mediated processes offer an eco-friendly and efficient alternative to the traditional multistep and environmentally harmful chemical processes. Herein we report the enzymatic synthesis of cladribine by a novel 20-deoxyribosyltransferase (NDT)-based combined biocatalyst. To this end, Lactobacillus delbrueckii NDT (LdNDT) was successfully immobilized through a two-step immobilization methodology, including a covalent immobilization onto glutaraldehydeactivated biomimetic silica nanoparticles followed by biocatalyst entrapment in calcium alginate. The resulting immobilized derivative, SiGPEI 25000-LdNDT-Alg, displayed 98% retained activity and was shown to be active and stable in a broad range of pH (5–9) and temperature (30–60 C), but also displayed an extremely high reusability (up to 2100 reuses without negligible loss of activity) in the enzymatic production of cladribine. Finally, as a proof of concept, SiGPEI 25000-LdNDT-Alg was successfully employed in the green production of cladribine at mg scale., Centro de Investigación y Desarrollo en Ciencias Aplicadas

Activation of the oncogene YAP has been shown to be related to lung cancer progression and associates with poor prognosis and metastasis. Metformin is a drug commonly used in the treatment of diabetes and with anticancer activity. However, the mechanism through which metformin inhibits tumorigenesis via YAP is poorly understood.The mRNA and protein expressions were analyzed by RT-PCR and western blot. The cellular proliferation was detected by CCK8 and MTT. The cell migration and invasion growth were analyzed by wound healing assay and transwell assay. The activities of promoter were analyzed by luciferase reporter assay. Chromatin immunoprecipitation detected the combining ability of IRF-1 and 5'UTR-YAP.Our immunohistochemistry staining and RT-PCR assays showed that the expression of YAP was higher in lung carcinoma samples. Interestingly, metformin was able to downregulate YAP mRNA and protein expression in lung cancer cells. Mechanistically, we found that metformin depressed YAP promoter by competing with the binding of the transcription factor IRF-1 in lung cancer cells. Moreover, combination of metformin and verteporfin synergistically inhibits cell proliferation, promotes apoptosis and suppresses cell migration/invasion by downregulating YAP, therefore reduces the side effects caused by their single use and improve the quality of life for patients with lung cancer.we concluded that metformin depresses YAP promoter by interfering with the binding of the transcription factor IRF-1. Importantly, verteporfin sensitizes metformin-induced the depression of YAP and inhibition of cell growth and invasion in lung cancer cells. FUND: This work was supported by National Natural Science Foundation of China (No.31801085), the Science and Technology Development Foundation of Yantai (2015ZH082), Natural Science Foundation of Shandong Province (ZR2018QH004, ZR2016HB55, ZR2017PH067 and ZR2017MH125), and Research Foundation of Binzhou Medical University (BY2015KYQD29 and BY2015KJ14).

Cisplatin is a chemotherapeutic agent widely used for the treatment of solid cancers. Its administration is commonly associated with acute and chronic gastrointestinal dysfunctions, likely related to mucosal and enteric nervous system (ENS) injuries, respectively. Glucagon-like peptide-2 (GLP-2) is a pleiotropic hormone exerting trophic/reparative activities on the intestine, via antiapoptotic and pro-proliferating pathways, to guarantee mucosal integrity, energy absorption and motility. Further, it possesses anti-inflammatory properties. Presently, cisplatin acute and chronic damages and GLP-2 protective effects were investigated in the mouse distal colon using histological, immunohistochemical and biochemical techniques. The mice received cisplatin and the degradation-resistant GLP-2 analog ([Gly2]GLP-2) for 4 weeks. Cisplatin-treated mice showed mucosal damage, inflammation, IL-1&beta, and IL-10 increase, decreased number of total neurons, ChAT- and nNOS-immunoreactive (IR) neurons, loss of SOX-10-IR cells and reduced expression of GFAP- and S100&beta, glial markers in the myenteric plexus. [Gly2]GLP-2 co-treatment partially prevented mucosal damage and counteracted the increase in cytokines and the loss of nNOS-IR and SOX-10-IR cells but not that of ChAT-IR neurons. Our data demonstrate that cisplatin causes mucosal injuries, neuropathy and gliopathy and that [Gly2]GLP-2 prevents these injuries, partially reducing mucosal inflammation and inducing ENS remodeling. Hence, this analog could represent an effective strategy to overcome colonic injures induced by cisplatin.

Intestinal mucositis, a cytotoxic side effect of the antineoplastic drug 5-fluorouracil (5-FU), is characterized by ulceration, inflammation, diarrhea, and intense abdominal pain, making it an important issue for clinical medicine. Given the seriousness of the problem, therapeutic alternatives have been sought as a means to ameliorate, prevent, and treat this condition. Among the alternatives available to address this side effect of treatment with 5-FU, the most promising has been the use of probiotics, prebiotics, synbiotics, and paraprobiotics. This review addresses the administration of these "biotics" as a therapeutic alternative for intestinal mucositis caused by 5-FU. It describes the effects and benefits related to their use as well as their potential for patient care.

INTRODUCTION: Cisplatin is a highly effective chemotherapeutic agent against a variety of solid tumors in adults and in children. Unfortunately, a large percentage of patients suffer permanent sensorineural hearing loss. Up to 60% of children and at least 50% of adults suffer this complication that seriously compromises their quality of life. Hearing loss is due to damage to the sensory cells in the inner ear, primarily the outer hair cells and cells of the stria vascularis and spiral ganglion. The mechanisms of cochlear damage are still being investigated. However, it appears that most damage to the inner ear is triggered by reactive oxygen species (ROS) formation and inflammation. AREAS COVERED: In this review we discuss a number of potential therapeutic targets that can be addressed to provide hearing protection. These strategies include enhancing the endogenous antioxidant pathways, heat shock proteins, G protein coupled receptors and counteracting enzymes that produce ROS and reactive nitrogen species, and blocking pathways that produce inflammation, including TRPV1 and STAT1. EXPERT OPINION: A number of potential protective agents show promise in animal models by systemic or local administration by transtympanic or intracochlear injection. However, clinical trials have not shown much efficacy to date with the exception of sodium thiosulfate administration in two studies of pediatric tumors. There is an urgent need to discover safe and effective protective agents that do not interfere with the efficacy of cisplatin against tumors yet preserve hearing.

Risk management for workers involved in the handling and preparation of cytotoxic drugs is challenging. This study aims to investigate drug contamination of the exterior surfaces of cytotoxic drug vials. Two batches of commercially available cytotoxic drugs in unprotected vials (ifosfamide, etoposide phosphate and cyclophosphamide) and plastic shrink wrap vials (doxorubicin, cytarabine and busulfan) were tested without removing the flip-off cap or the plastic wrap, and without prewashing. The results showed significant trace amounts of cytotoxic drugs on the exterior surfaces in both unprotected (eg, cyclophosphamide, ifosfamide) and protected plastic shrink wrap vials (eg, cytarabine), indicating that the secondary packaging of protected vials does not systematically prevent exposure to the handlers. These results focus on the need for guidelines to prevent cytotoxic vial contamination and safety recommendations for staff in the handling and storage of these vials.

Antineoplastic drugs (AD) are important chemical risks for healthcare workers. Precautions against AD exposure include the use of appropriate personal protective equipment (PPE). Evaluation of PPE usage during patient care processes has not been reported in Thailand. We aimed to evaluate the level of PPE usage and factors predicting PPE usage among nurses and nurse assistants in Thailand. A cross-sectional survey was conducted in a university hospital and two general hospitals. The questionnaires covered demographic characteristics, self-reported use of PPE and 7 predictive factors. Mixed-effects modeling was used to determine the association between standardized score of predictive factors and PPE usage score. The response rate was 78.6% and 884 participants were left for analysis after data cleaning. Among nurses (n = 499), higher PPE usage score was associated with self-efficacy (β = 0.28, 95% CI 0.21, 0.34), workplace safety climate (β = 0.27, 95% CI 0.20, 0.34), and conflict of interest (β = − 0.07, 95% CI − 0.14, − 0.01). Among nurse assistants (n = 385), higher PPE usage score was associated with self-efficacy (β = 0.27, 95% CI 0.18, 0.36), interpersonal influence (β = 0.14, 95% CI 0.04, 0.24), workplace safety climate (β = 10.29, 95% CI 0.19, 0.38), and conflict of interest (β = − 0.14, 95% CI − 0.24, − 0.03). Several factors were associated with PPE usage among nurses and nurse assistants. Improved PPE usage against AD can be promoted through interventions that modify those factors.

The antineoplastic drug Carmofur was shown to inhibit SARS-CoV-2 main protease (Mpro). Here the X-ray crystal structure of Mpro in complex with Carmofur reveals that the carbonyl reactive group of Carmofur is covalently bound to catalytic Cys145, whereas its fatty acid tail occupies the hydrophobic S2 subsite. Carmofur inhibits viral replication in cells (EC50 = 24.30 μM) and it is a promising lead compound to develop new antiviral treatment for COVID-19.

Background and importance Several studies have shown that antineoplastic drug contamination is found on various work surfaces in hospitals and varies widely on wards. The MASHA project (research about environmental contamination by cytotoxics and management of safe handling procedures) was to set up to conduct new research, in cooperation with the European Society for Medical Oncology, into contamination levels in hospital wards. Aim and objectives To obtain an overview of the current levels of cytotoxic contamination in European hospital wards and increase awareness among healthcare workers and their employers about the risks associated with working with hazardous drugs, and to provide them with additional measures to improve safety. Material and methods The assessment of surface contamination with cytotoxic drugs was done by evaluating wipe samples collected from four comparable surfaces on the wards (work benches, floors, armrest of patient’s chair and lids of waste containers). Each sample was analysed for the presence of five commonly used cytotoxic drugs (cyclophosphamide, 5-fluorouracil, paclitaxel, gemcitabine and total platinum for platinum drugs), using ICP-MS for total platinum and LC-MS/MS for other substances. Results The database includes results collected from 28 hospital units from 16 European countries. Of the 560 samples collected, 268 were positive (48%). Measurable amounts of at least one substance were detected on investigated surfaces in every hospital: 21/28 (75%) hospitals had over 30% positive samples. Contamination was detected mostly on the floors (58%), armrests (50%), lids (42%) and work benches (40%). The highest values were found for cyclophosphamide (380 ng/cm2) and 5-fluorouracil (130 ng/cm2) on the lids. The highest number of positive results were recorded with platinum drugs (33%), 5-fluorouracil (25%), gemcitabine (19%) and cyclophosphamide (18%). Substances were detected on 45/112 of surfaces (40%) which had not been used for cytotoxic drug preparation on the day of the wipe sampling. Conclusion and relevance Contamination is detectable on the ward but at different levels in different hospitals. Cleaning procedures are still not effective. Therefore, evaluation of exposure of healthcare workers is crucial. Greater collaboration with medical and nurse societies, to improve safe handling procedures in hospitals and thus improve the safety of all healthcare workers, is required. References and/or acknowledgements No conflict of interest.

The overall survival for children with cancer in high income countries is excellent. However, there are many disparities that may negatively affect survival, which are particularly problematic in low income countries, such as nutritional status at diagnosis and throughout therapy. Nutritional status as well as concomitant foods, supplements, and medications may play a role in overall exposure and response to chemotherapy. Emerging science around the microbiome may also play a role and should be further explored as a contributor to disease progression and therapeutic response. This article highlights some of these issues and proposes additional areas of research relevant to nutritional status and pharmacology that are needed in pediatric oncology.

An antineoplastic drug-free anticancer strategy enabled by host defense peptides (HDPs)-mimicking synthetic polypeptides is reported. The polypeptide exhibits a broad spectrum of anticancer activity in 12 cancer cell lines, including drug-resistant and highly metastatic tumor cells. Detailed mechanistic studies reveal that the cationic anticancer polypeptide (ACPP) can directly induce rapid necrosis of cancer cells within minutes through a membrane-lytic mechanism. Moreover, a pH-sensitive zwitterionic derivative of ACPP (DA-ACPP) is prepared for in vivo application. DA-ACPP shows negligible hemolysis under neutral physiological conditions, and can be converted back to ACPP in slightly acidic tumor environments, resulting in selective killing of cancer cells. Consequently, DA-ACPP shows an effective inhibition of tumor growth in both 4T1 orthotopic breast tumor models and B16-F10 melanoma pulmonary metastatic models. Overall, these findings demonstrate that synthetic HDPs-mimicking polypeptides represent safe and effective antineoplastic agents, which sheds new light on the development of drug-free synthetic polymers for cancer therapy.

Background: Taxus is a valuable woody species with important medicinal value. The bark of Taxus can produce taxol, a natural antineoplastic drug that is widely used in the treatment of breast, ovarian and lung cancers. However, the low content of taxol in the bark of Taxus can not meet the growing clinical demands, so the current research aims at finding ways to increase taxol production. Objective: In this review, the research progress of taxol including the factors affecting the taxol content, biosynthesis pathway of taxol, production of taxol in vitro and the application of multi-omics approaches in Taxus as well as future research prospects will be discussed. Results: The taxol content is not only dependent on the species, age and tissues but is also affected by light, moisture levels, temperature, soil fertility and microbes. Most of the enzymes in the taxol biosynthesis pathway have been identified and characterized. Total chemical synthesis, semi-synthesis, plant cell culture and biosynthesis in endophytic fungi have been explored to product taxol. Multi-omics have been used to study Taxus and taxol. Conclusion: Further efforts in the identification of unknown enzymes in the taxol biosynthesis pathway, establishment of the genetic transformation system in Taxus and the regulatory mechanism of taxol biosynthesis and Taxus cell growth will play a significant role in improving the yield of taxol in Taxus cells and plants.

Securing potable water and preserving aquatic ecosystems are growing problems that will become even more important in the near future. Well-defined environmental pollutants such as pesticides, heavy metals, or organic matter have been thoroughly examined, but over the recent decade, a spotlight was put on a new and emerging group of pollutants – pharmaceuticals, antineoplastic drugs being considered as the most hazardous ones among these. Patients’ excretion is the most important routes by which antineoplastic residues end up in the effluents from hospitals and households and reach freshwater where aquatic organisms can be affected. Low concentrations of antineoplastic drug can be expected in occupational settings, and medical staff could be chronically exposed to these highly active agents, representing a potential threat to their health.

Background To prevent occupational exposure of hospital staff to cytostatics, a mandatory national guideline describing a set of safety measures was issued in the Netherlands in 2004. The guideline includes, among other directives, obligatory annual wipe testing to assess the efficacy of the local cleaning protocol. Full implementation of this guideline was executed in all Dutch hospital pharmacies over the next couple of years. Objective We aimed to investigate the effect of the national guideline on contamination levels, and specifically on the phenomenon of carry-over of traces of antineoplastic drugs through contact with surfaces, since this is a potential route of exposure. Methods From a database including wipe sample results of 9 hospitals over 10 years, we extracted all sampled locations in the compounding areas as well as in adjacent or bypass rooms and locks. We considered only the locations outside safety cabinets or isolators, to examine the containment of contamination and to address possible routes of how a contamination can migrate through the preparation and distribution areas. The dataset consisted of 2647 wipe samples. Results In adjacent rooms, 18 out of 275 wipe samples were contaminated (6%). Inside the compounding room, the extracted locations away from the safety workbench showed a positive percentage for contamination of 13% (39 out of 297). When stratifying the data to sample year, it was shown that contaminations outside the preparation room were no longer detectable after 2008. Conclusion With this study, we show that implementation of a set of guidelines on safety measures can prevent spreading of cytostatic traces from the compounding area in hospital pharmacies.

Capectiabine is an oral antineoplastic drug used in multiple malignancies. Proton pump inhibitors (PPI) have been proven to interact with other oral antineoplastic agents. In this systematic review we will summarize the clinical evidence on the efficacy of capecitabine when used concomitantly with PPI. We performed a systematic literature search on the main databases up to November 2019. Nine studies met our inclusion criteria: 8 retrospective studies and 1 phase II clinical trial. Patients with colorectal, breast and gastroesophageal were represented. Four out of the 9 studies reported a shorter efficacy outcome in uni- or multivariate analysis when capecitabine was taken concomitantly with PPI than alone. Up to date, the clinical evidence reported on the use of capecitabine concomitantly with PPI is scarce and shows conflicting results. While awaiting further data, avoiding misuse of PPI in cancer patients taking capecitabine is recommended.

Cancer clinical practice guidelines recommend different treatment options for different cancer types and are mainly developed by clinicians. In theory, those recommendation schemes that are supported by scientific research should provide better efficacy for patients. However, in actual clinical practice: “Is the choice of a specific antineoplastic drug for a specific cancer supported by the results of molecular biology mechanisms or based on the subjective experience of the clinician?” Answering this question is of significant importance for guiding clinical practice, but there is currently no operational method to provide objective judgment in specific cases. This paper describes a literature mining method that collates information from specific antineoplastic drug-related literature to establish an antineoplastic drug-gene association matrix for global or specific cancer scenarios, and further establishes a standard model and scenario models. Based on the parameters of these models, we constructed a linear regression analysis method to evaluate whether the models in different scenarios deviated from a random distribution. Finally, we determined the possible efficacy of an antineoplastic drug in different cancer types, which was validated by the Genomics of Drug Sensitivity in Cancer (GDSC) database. Using our mining method, we tested 18 antineoplastic drugs in 16 cancer types. We found that cisplatin used in ovarian cancer was more efficacious and may benefit patients more than when used in breast cancer, which provides a new paradigm for rational knowledge-driven drug distribution patterns in clinical practice.

Chemotherapy-induced peripheral neurotoxicity (CIPN) is a potentially dose-limiting side effect of the treatment of several cancers. CIPN is predominantly or exclusively sensory, and it is frequently associated with unpleasant symptoms, overall referred to as "pain." However, given the markedly different clinical presentation and course of CIPN depending on the antineoplastic drug used, the broad term "pain" in the specific context of CIPN needs to be reconsidered and refined. In fact, a precise identification of the features of CIPN has relevant implication in the design of rational-based clinical trials and in the selection of possible active drugs.

What is known and objectiveMedication errors are a significant cause of morbidity and mortality especially with antineoplastic drugs, owing to their narrow therapeutic index. Gravimetric workflow software systems have the potential to reduce volumetric errors during intravenous antineoplastic drug preparation which may occur when verification is reliant on visual inspection. Our aim was to detect medication errors with possible critical therapeutic impact as determined by the rate of prevented medication errors in chemotherapy compounding after implementation of gravimetric measurement.DesignA large-scale, retrospective analysis of data was carried out, related to medication errors identified during preparation of antineoplastic drugs in 10 pharmacy services (centres) in five European countries following the introduction of an intravenous workflow software gravimetric system. Errors were defined as errors in dose volumes outside tolerance levels, identified during weighing stages of preparation of chemotherapy solutions which would not otherwise have been detected by conventional visual inspection.Key resultsThe gravimetric system detected that 7.89% of the 759060 doses of antineoplastic drugs prepared at participating centres between July 2011 and October 2015 had error levels outside the accepted tolerance range set by individual centres, and prevented these doses from reaching patients. The proportion of antineoplastic preparations with deviations >10% ranged from 0.49% to 5.04% across sites, with a mean of 2.25%. The proportion of preparations with deviations >20% ranged from 0.21% to 1.27% across sites, with a mean of 0.71%. There was considerable variation in error levels for different antineoplastic agents.What is new and conclusionIntroduction of a gravimetric preparation system for antineoplastic agents detected and prevented dosing errors which would not have been recognized with traditional methods and could have resulted in toxicity or suboptimal therapeutic outcomes for patients undergoing anticancer treatment.

Fenretinide (4-HPR) is a synthetic retinoid that has cytotoxic activity against cancer cells. Despite substantial in vitro cytotoxicity, response rates in early clinical trials with 4-HPR have been less than anticipated, likely due to the low bioavailability of the initial oral capsule formulation. Several clinical studies have shown that the oral capsule formulation at maximum tolerated dose (MTD) achieved Impact statement One of the critical components in drug development is understanding pharmacology (especially pharmacokinetics) of the drugs being developed. Often the pharmacokinetic properties, such as poor solubility leading to poor bioavailability, of the drug can limit further development of the drug. The development of numerous drugs has often halted at clinical testing stages, and several of them were due to the pharmacological properties of the agents, resulting in increased drug development cost. The current review provides an example of how improved clinical activity can be achieved by changing the formulations of a drug with poor bioavailability. Thus, it emphasizes the importance of understanding pharmacologic characteristics of the drug in drug development.

Carbon dots (CDs) hold great promise as a class of fluorophores for bioimaging. Here, we report a simple solvothermal approach to prepare photoluminescent CDs derived from the antineoplastic drug etoposide. The CDs show photoluminescence ranging from 365 to 650 nm when excited at 360 nm. When excited at 405, 488 and 543 nm, strong blue, green and red fluorescence can be detected. Our experiments reveal that the CDs can penetrate into the cells in a short time and remain emissive, even at low temperature. Also, optical signals can be detected from mice after hypodermic or intravenous injection. We demonstrated that the CDs can serve as a low-cytotoxicity biological imaging agent for bioimaging in vitro and in vivo.

Voltammetric behavior of the antineoplastic drug 5-fluorouracil is for the first time studied on polished copper solid amalgam electrode. It was proved that the presence of the copper in the electrode material is advantageous for the determination of 5-fluorouracil, and one well-developed cathodic signal belonging to the reduction of the absorbed complex of 5-fluorouracil–Cu(II) was found as suitable for its precise determination. The highest response was recorded in Britton–Robinson buffer of pH 8 and excellent results like repeatability of measurements and determination as well or limit of detection (1.2 × 10−9 mol L−1) were reached. Moreover, the proposed method was successfully applied to the analysis of pharmaceutical sample with excellent recovery (97.0–100.9%).

The United States Pharmacopeia (USP) Chapter800guidelines will be adopted in the U.S. and Canada in 2019, requiring regular surface sampling for antineoplastic drug (AD) surface contamination as a means of environmental surveillance. USP Chapter800does not provide guidance on when and where to sample. Research to support the development of such guidance within a broader sampling strategy is limited. This study was conducted to help address some of the underlying information gaps by identifying surfaces pharmacy and nursing staff are likely to contact, presenting a potential dermal exposure risk. Observations were conducted at one regional and one urban clinic, providing insight into inter- and intra-worker variability and between-clinic differences based on size and patient load. Thirteen surfaces in the compounding pharmacies and 14 surfaces in the patient administration were initially selected for video observations. Following a preliminary assessment to eliminate surfaces that were touched infrequently or not at all, five commonly touched surfaces in the compounding pharmacy areas (vials, syringes, IV lines, IV bags, waste bags) and six commonly touched surfaces in the patient administration area (yellow containment bag, IV bag, IV line, patient port, computer workstation) were assessed further. Variability between healthcare staff and clinics in pharmacy staff was low for both the mean frequency and duration of touch to surfaces. Differences between clinics in frequency of contact among nursing staff in patient administration areas were significant (two-way ANOVA) for five of the six surfaces. Duration of contact was not significantly different except for duration of touching the IV pump. These insights will be used to give guidance in selecting locations for a longitudinal surveillance study and help tailor worker training to reduce exposure risks.

Introduction Contamination of hospitals’ surfaces with antineoplastic drugs is documented despite safe handling practices. The exterior of commercial containers is often contaminated during the manufacturing process and can cross-contaminate hospitals’ surfaces. The aim was to investigate the contamination of the exterior of antineoplastic drug vials available in Canada in 2018. Methods Cross-sectional study. All available antineoplastic drugs vials from a single wholesaler were targeted. Containers were sampled upon their receipt by the pharmacy staff, before they were cleaned. One wipe was used to sample the external surface of five vials from a single batch from the same manufacturer. Nine antineoplastic drugs were quantified by ultra-performance liquid chromatography–tandem mass spectrometer: cyclophosphamide, docetaxel, 5-fluorouracil, gemcitabine, ifosfamide, irinotecan, methotrexate, paclitaxel, vinorelbine. Results Twenty-one samplings were done (105 containers from nine different manufacturers): cyclophosphamide = 2, docetaxel = 1, gemcitabine = 2, 5-fluorouracil = 2, ifosfamide = 2, irinotecan = 3, methotrexate = 6, paclitaxel = 2, vinorelbine = 1. One of these samplings was done on blister packaging, the remainder were done on glass vials. A total of 15/21 samples (71%) were positive to at least one drug (docetaxel, 5-fluorouracil, ifosfamide, and vinorelbine). A maximum of 272 ng/vial was quantified (gemcitabine). Cross contamination with other antineoplastic drugs was detected on 16/21 (76%) samples. Conclusion The majority of samples were positive to at least one antineoplastic drug, confirming that the exterior of antineoplastic drugs containers is still an important source of contamination. Manufacturers should reduce this contamination. Vials should be washed upon receipt, before they are stored in pharmacy. Gloves must be worn at all times to avoid occupational exposure.

Chemotherapeutic medications, including 5 - fluorouracil (5FU), are the same old technique to most cancers and are associated with numerous peripheral toxicities. We investigated exopolysaccharide (EPSST) produced from the isolated streptomycete of the Mediterranean Sea for the capability to lower the severity of mucositis

Cisplatin, an effective antineoplastic drug used in the treatment of many cancers, has ototoxic potential, thus placing cancer patients, receiving this treatment, at risk of hearing loss. It is therefore important for health care professionals managing these patients to be aware of cisplatin's ototoxic properties and its clinical signs to identify patients at risk of developing a hearing impairment. Eighty-five English peer-reviewed articles and two books, from January 1975 to July 2015, were identified from PubMed, ScienceDirect, and EBSCOhost. An overview of cisplatin-associated ototoxicity, namely its clinical features, incidence rates, molecular and cellular mechanisms, and risk factors, is presented in this article. This review further highlights the importance of a team-based approach to complement an audiological monitoring program in reducing any further loss in the quality of life of affected patients, as there is currently no otoprotective agent routinely recommended for the prevention of cisplatin-associated ototoxicity.