Antineoplastic Agents: Environmental Prevalence and Adverse Outcomes in Aquatic Organisms

Area of Science:

• Environmental toxicology
• Ecotoxicology
• Environmental chemistry

Background:

• Cancer is a leading cause of death globally, with rising incidence correlating with increased chemotherapy drug use.
• Antineoplastic agents are frequently detected in aquatic environments due to incomplete removal during wastewater treatment.
• Growing environmental presence of these drugs necessitates an understanding of their ecological impact.

Purpose of the Study:

• To review and synthesize current knowledge on the environmental prevalence of antineoplastic agents.
• To assess the ecotoxicological risks of these pharmaceuticals to aquatic organisms.
• To summarize biological impacts and propose an adverse outcome pathway for specific antineoplastics.

Main Methods:

• Conducted two separate literature reviews to gather data on global environmental occurrence and toxicity of antineoplastics.
• Synthesized findings on the detection levels and biological effects of prevalent antineoplastic drugs in aquatic ecosystems.
• Focused on cyclophosphamide, ifosfamide, tamoxifen, methotrexate, and 5-fluorouracil.

Main Results:

• Cyclophosphamide, ifosfamide, tamoxifen, methotrexate, and 5-fluorouracil were frequently detected in various water sources (effluent, surface water).
• These drugs represent different mechanistic classes: alkylating agents, hormonal agents, and antimetabolites.
• Data on the ecotoxicological risk of antineoplastics in aquatic environments are limited.

Conclusions:

• Antineoplastic agents are environmentally prevalent and pose potential risks to aquatic life.
• An adverse outcome pathway was proposed for cyclophosphamide and ifosfamide, highlighting their immunotoxic effects.
• Urgent need for acute and chronic ecotoxicity studies to enable robust environmental risk characterization.