Environmental and biological monitoring of workers exposed to antineoplastic drugs. Dose and effect biomarkers

Antineoplastic drugs are among the most widespread drugs. Consequently, workers involved in their handling and management could be exposed to hazardous chemicals. However, even if procedures are established, it is of the utmost importance that attention on this issue never faint. For these reasons, our Institution is always very attentive and has conducted a specific study in collaboration with “Sapienza”, Rome University. An environmental monitoring campaign, combined with biological monitoring, was carried out in an oncology ward of a hospital in central Italy. Cyclophosphamide, ifosfamide, cytarabine, dacarbazine, doxo and epirubicine, gemcitabine, methotrexate and 5‑fluorouracile were selected for this study due to their diffusion. A wipe‑sampling procedure followed by a LC‑MS/MS analysis was used to evaluate the contamination of benches, hood and general surfaces inside the “Unit for cytotoxic drug preparations” (Unità Farmaci Antiblastici‑UFA). A Solid Phase Extraction procedure coupled with the same LC‑MS/MS method was applied to analyze urine samples of the workers involved in cytotoxic drugs handling. Moreover, biomarkers of oxidative stress were analyzed on the same biological samples in order to evaluate if a correlation exists between drugs exposure and damages to proteins, RNA and DNA. Results showed the presence of one or more of the selected analytes on the surfaces before the cleaning procedure but, worryingly, also after it. Biological monitoring followed a similar trend showing the presence of cyclophosphamide, dacarbazine, methotrexate, cytarabine and 5‑fluorouracile in different samples. Urinary concentration of 8‑oxo‑7,8‑dihydro‑2’‑deoxyguanosine was found higher than that of a group of healthy volunteers not exposed to antineoplastic drugs, showing a possible effect of cytarabine on biomarkers of DNA oxidative stress. Outcomes raised from the analyzed samples and the biomarkers evaluation highlighted the presence of many critical issues. Contamination depends on many factors, such as working modalities and cleaning procedures, however specific training courses as well as continuous monitoring plans for risk assessment are still extremely important to protect the workers’ health.