Abstract
Environmental risks imposed by anti-cancer drugs and their degradation products are a major concern worldwide. The consumption of anticancer drugs is increasing throughout the years and conventional water treatment processes seem to be ineffective for their removal. The aim of this study is to analyze the consumption of anticancer drugs in Lebanon and assess their potential health hazard as contaminants of the Lebanese surface waters. Anticancer drugs consumption data between the years 2013 and 2018 were collected and the following parameters were calculated: yearly consumption of single active ingredients, yearly consumption of drug equivalents (for drugs belonging to the same pharmacologic class having the same active ingredient) and Predicted Environmental Concentrations (PECs). The obtained PEC values were used to stratify compounds into risk categories. The top five most commonly consumed drugs are Mycophenolate mofetil, Hydroxycarbamide, Capecitibine, Mycophenolic acid and Azathioprine. Based on the calculated PEC values of single active ingredients as well as their equivalents, six high-risk priority compounds were identified: Mycophenolate mofetil, Hydroxycarbamide, Capecitibine, Mycophenolic acid, Azathioprine and 5-Fluorouracil. The impact of these micropollutants on animals as well as humans was analyzed. This research stresses the importance of further analysis of chemotherapy micropollutants with major focus on high-risk drugs. Additionally, regulations should be set in place to ensure proper management of wastewater and the development of efficient wastewater treatment plants.
Highlights
Cancer is the second leading cause of death in the world
Capecitabine is a prodrug that is enzymatically converted to fluorouracil in the tumor, where it inhibits DNA synthesis and slows growth of tumor tissue [9, 18]
The environmental toxicity of capecitabine should be analyzed as part of that of Fluorouracil
Summary
Cancer is the second leading cause of death in the world. Every sixth death in the world is due to cancer [1]. In Lebanon, the number of new cancer cases diagnosed in 2018 were 17,294 (288 cases per 100,000 population) with breast, bladder, lung, prostate, and colorectal cancers being the most common [2]. As the world population is growing and aging, the global number of cancer death is expected to increase further. Environmental risk assessment of anti-cancer drugs and their transformation products is a major concern; studies have been conducted to analyze chemotherapy drugs consumption trends, presence in surface water and population exposure. This is due to two main factors: the consumption
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