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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.

Chemotherapeutic drugs in Lebanese surface waters: estimation of population exposure and identification of high-risk drugs