The approach to cancer chemotherapy has changed in recent years, and there are several new oral chemotherapeutics that offer convenience to patients. These medications have toxicity, which may be particularly amplified in an overdose.

This was a retrospective review of all oral chemotherapy overdoses reported to the California Poison Control System between January 2009 and December 2019. Inclusion criteria were all ingestions coded as “antineoplastic, monoclonal antibody, or thalidomide” that were evaluated at a health care facility. We evaluated outcomes per AAPCC criteria (stratified as death, major, moderate, mild, or no effect) as well as symptoms and interventions.

There were 314 total cases reported; 169 single-substance ingestions (54%) and 145 cases with coingestant(s) (46%). One hundred eighty cases were female (57%) and 134 male (43%). Age ranges were as follows: ages 1–10 years old (87 cases); ages 11–19 years old (26 cases); 20–59 years old (103 cases); ages 60 and older (98 cases). The majority of cases were unintentional ingestions (199, 63%). The most common medication reported was methotrexate with 140 cases (45%), followed by anastrozole (32 cases) and azathioprine (25 cases). One hundred thirty-eight cases were admitted to the hospital for further care (ICU 63 cases; non-ICU 75 cases). Eighty-four of the methotrexate cases received the antidote leucovorin (60%). Five of the capecitabine ingestions received uridine (36%). Outcomes included 124 cases with no effect, 87 cases with minor effect, 73 case with moderate effect, 26 cases with major effect, and 4 deaths.

Although methotrexate is the most common oral chemotherapeutic agent involved in overdoses reported to the California Poison Control System, there are many other oral chemotherapeutics from various drug classes, which can lead to toxicity. Although deaths are rare, further studies are needed to determine if particular drugs or drug classes warrant more scrutiny.