Pan Birmingham Cancer Network

There is increasing concern amongst chemotherapy nurses that nurses of child bearing potential will be handling an increasing range and dosage of mAbs over the coming years, and that they are potentially exposed or potentially exposing an unborn fetus to these agents.

Cytotoxic drugs were not considered a handling hazard for many years until their mechanisms of action on genetic material were elucidated and epidemiological evidence emerged linking them to late adverse effects. Monoclonal antibodies acting at molecular level are new agents and their interactions with their cellular targets and the possible cascaded consequences of those interactions down to nuclear level are not clearly understood.

It is therefore understandable that staff do not want to wait several years before any possible long term effects of mAbs are seen and evidence to support safe handling strategies emerge.

This local guideline suggests that nurses preparing MABs in clinical areas should use Trust approved closed system reconstitution / safe transfer devices such as Chemfort™ where these exist and are appropriate for the specific type of manipulation required.