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Systemic Treatment Administration

In June 2018, Cancer Care Ontario became aware of a hospital issue relating to the administration of three systemic treatment drugs (Pembrolizumab, Nivolumab and Panitumumab) where more than the expected amounts of the drug remained in the IV tubing, resulting in variation in intended dose delivery to some patients.

On Tuesday, June 26, Cancer Care Ontario sent a Safety Bulletin to all 74 Ontario hospitals that deliver systemic treatment asking them to review hospital policies and procedures for all low volume, high concentration medications, to ensure that the intended dose is reaching the patient.

All 74 hospitals reviewed their processes and reported their findings to Cancer Care Ontario.

In total, we learned that 35 out of 74 hospitals identified process issues dating back to the initial administration of the three drugs. Of the 35 hospitals, 28 identified approximately 1,000 patient records for review by the medical team, and the reviews have been completed. The other seven hospitals identified process issues but no patients were treated with the drugs at those sites.

All of the impacted hospitals took immediate steps to correct the issue through changing their practices and notified affected patients based on the hospitals’ procedures and policies.

Cancer Care Ontario has initiated a plan to work with its hospital partners to do a thorough root cause analysis to understand the factors that may have contributed to this issue. In addition, we are updating our clinical guidelines for the safe administration and handling of systemic treatment, and we will ensure that learnings from the root cause analysis and guideline update are included in the approved education for specialized oncology nurses delivering systemic treatment in Ontario.

We recognize this can be concerning for patients and their families. Patients who are unsure whether their treatment may have been affected are encouraged to contact their hospital and speak to their physician.

Definition of Systemic Treatment

  • Chemotherapy treatment is the use of drugs that slow or stop cancer cells from growing, multiplying or spreading to other parts of the body.
  • Targeted therapy is a type of treatment that targets a cancer’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival.
  • Immunotherapy is a type of treatment to stimulate or restore the ability of the immune (defense) system to fight infection and disease.

Pembrolizumab, Nivolumab and Panitumumab

Pembrolizumab, Nivolumab and Panitumumab are used to treat locally advanced and metastatic cancers. Pembrolizumab and Nivolumab are immunotherapies, and Panitumumab is a targeted therapy.


  • Pembrolizumab is used for treating a type of skin cancer (melanoma) or lung cancer (non-small cell) that has spread or cannot be removed by surgery.
  • Nivolumab is used for treating a type of skin cancer (melanoma), lung cancer (non-small cell), kidney cancer (renal cell) or head and neck cancer that cannot be removed by surgery or has spread to other parts of the body. It may also be used for treating Hodgkin Lymphoma, a type of blood cancer.
  • Panitumumab is used for treating colorectal, small bowel or appendiceal cancer that has spread to other organs in the body.