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</o:shapelayout></xml><![endif]--></head><body lang=EN-US link=blue vlink=purple><div class=WordSection1><p class=MsoNormal>Regarding the potential of antineoplastics and RCRA drugs to enter ground or surface waters, I completed a 2 year EPA funded study of pharmaceutical wasting.<o:p></o:p></p><p class=MsoNormal><span style='font-size:10.0pt'>79 drugs are used in cancer treatment at an 650 bed academic medical center hospital and an affiliated 23 hour, 20 bed surgical care center (AMCH and SCC). No drug used in cancer treatment appeared in the listing of the top 200 drugs for 2009 (http://www.drugs.com). Of the 11 RCRA and 79 cytotoxic drugs, three RCRA and 11 cytotoxic are not excreted as unchanged drug and could not appear in “yellow water”. Seven RCRA and 32 cytotoxic drugs do not have pharmacologically active metabolites formed in vivo. (Data Tables are available on request).<o:p></o:p></span></p><p class=MsoNormal><span style='font-size:10.0pt'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-size:10.0pt'> The average PBT (pesistence, bioaccumulating and toxicity value from http://www.janusinfo.se) for the Chemo drugs was 5.0 (the same as the average PBT for the top 200 drugs of 2009). Four drugs (5%) were rated 7, 8 or 9/9 (docetaxel – 9/9, everolimus – 8/9, megstrol – 9/9, and tamoxifen – 9/9). Seventeen drugs (22%) had a moderate PBT rating of 4, 5 or 6/9 while 7 (9%) had a rating of 1, 2 or 3 for PBT. Fifty one (51) Chemo drugs (65%) were not rated for PBT. <o:p></o:p></span></p><p class=MsoNormal><span style='font-size:10.0pt'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-size:10.0pt'>The environmental risk ratio (based on the ratio between predicted environmental concentration of the substance (PEC) and the highest concentration of the substance that does not have a harmful effect in the environment (PNEC)) for these 79 cytotoxic, antineoplastic drugs was minimal with 12 (15%) rated as ”Insignificant” (PEC/PNEC <0.1), and 27 drugs (34%) rated as ”Cannot be excluded” . Thirty nine (49%) of these drugs were not rated or had no data available for PEC/PNEC ratio. <o:p></o:p></span></p><p class=MsoNormal><span style='font-size:10.0pt'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-size:10.0pt'>No cytotoxic, antineoplastic or Immunomodulatory (e.g., Chemo) drugs were bedside wasted over the 2 year course of the study. Between 200 and 300 pounds per year of antineoplastic drug waste is generated in the course of cancer treatments. These wastes include partially administered drug or outdated materials returned to the pharmacy for disposal. These wastes were shipped for secure destruction at an EPA registered hazardous waste incinerator (TSDF). <o:p></o:p></span></p><p class=MsoNormal><o:p> </o:p></p><p class=MsoNormal><o:p> </o:p></p><p class=MsoNormal>Dr. Russell Mankes<o:p></o:p></p><p class=MsoNormal>141 Mohawk Dr<o:p></o:p></p><p class=MsoNormal>Schenectady, NY 12303-5732<o:p></o:p></p><p class=MsoNormal>518-355-1330<o:p></o:p></p><p class=MsoNormal>518-495-9775 (cellular)<o:p></o:p></p><p class=MsoNormal>Rmankes@nycap.rr.com<o:p></o:p></p><p class=MsoNormal>Tpathology@aim.com<o:p></o:p></p><p class=MsoNormal><o:p> </o:p></p></div></body></html>