Cincinnati, OH: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, DHHS (NIOSH) Publication No. 2004-102, 2004 Sep; :1-13
Antineoplastic agents are widely used in cancer therapy because they can inhibit growth by disrupting cell division and killing actively growing cells. These agents can also cause health effects among health care workers who work with them. A summary of these health risks and means for protecting workers are available in a recent NIOSH Alert [NIOSH 2004]. The following list contains commonly used antineoplastic agents and some of the cancers treated by these agents [Rogers 1987; Chabner et al. 1996; Jochimsen 1992; McFarland et al. 2001]. Alkylating agents (interfere with normal mitosis and cell division): Chlorambucil (Leukeran) - breast, lung, ovarian, and testicular cancer; Hodgkin's disease; Cyclophosphamide (Cytoxan) - multiple myeloma; breast, lung, and ovarian cancer; and, Carmustine (BiCNU) - malignant melanoma, brain tumors. Antimetabolites (interfere with folic acid, purine, and pyrimidine synthesis): Methotrexate (Mexate) - leukemia, breast, and lung cancer; Fluorouracil (Adrucil) - bladder, liver, pancreatic, lung, and breast cancer; and, Mercaptopurine (Purinethol) - acute leukemia. Antibiotics (cause single- and double-strand DNA breaks): Actinomycin D (Cosmegen) - Kaposi's sarcoma, rhabdomyosarcoma; Doxorubicin (Adriamycin) - acute leukemia, breast cancer; and, Bleomycin (Bleo) - Hodgkins/non-Hodgkins lymphoma, testicular cancer. Natural products (antimitotic agents) (block mitosis and produce metaphase arrest): Vinblastine (Velban) - non-Hodgkin's lymphoma, breast and testicular cancer; Vincristine (Oncovin) - small-cell lung cancer, non-Hodgkin's lymphoma; and, Paclitaxel (Taxol) - ovarian and breast cancer. Miscellaneous agents: Hydroxyurea (Hydrea) - acts as an antimetabolite in S phase; malignant melanoma, metastatic ovarian cancer; and, Estrogens - interfere with hormone receptors and proteins in all phases of cell cycle; prostate cancer, postmenopausal advanced breast cancer. Some of these antineoplastic agents are also being used for other purposes such as the treatment of nonmalignant diseases. Examples include the use of methotrexate for rheumatoid arthritis [Baker et al. 1987], cyclophosphamide for multiple sclerosis [Moody et al. 1987], and 5-fluorouracil for psoriasis [Abel 2000]. The purpose of this brochure is to: 1. make you aware of the adverse health effects of antineoplastic agents; 2. describe how you can be exposed to these agents; and, 3. provide and identify control methods and work practices to prevent or reduce your exposure to antineoplastic agents.