Introduction: Adriamycin and cyclophosphamide (AC) combination chemotherapy is one of the common regimens used for breast cancer and in metastatic breast cancer with oligo-metastasis. (1) AC combination chemotherapy regimen is associated with adverse drug reactions like myelosuppression, gastrointestinal toxicity, cardiotoxicity, peripheral neuropathy, and hand-foot syndrome. (2),(3),(4) It has been noticed from previous studies that the metabolism-related gene GSTP rs 1695 homozygous mutant allele has been associated with higher incidences of myelotoxicity and gastrointestinal toxicity post-combination chemotherapy regimens. (5) Case report: A 55-year-old female patient presented with the incidence of grade 3 febrile neutropenia and myelosuppression, 8 days following AC infusion. The patient also has symptoms of grade 2 peripheral neuropathy and diarrhea. She was treated as an inpatient from the local hospital with pegfilgrastim, packed RBC transfusion, and intravenous antibiotics for febrile neutropenia. She recovered completely with this treatment and was discharged without any sequelae or complications. She was then tested for the GSTP rs 1695 gene which revealed the homozygous mutant variant (GG allele). When reporting the causal association of the adverse drug reaction, it comes under the “possible” category of WHO causality assessment. Conclusion: Myelosuppression, Diarrhea, and other adverse events following AC combination chemotherapy can be related to the Genetic polymorphism in GSTP rs 1695 double mutant homozygous allele (GG ) and its altered drug metabolism effects. The Adverse drug reaction comes under the “Possible” Category of WHO causality assessment. Key Words: Adriamycin, Myelosuppression, Cyclophosphamide, Hand-foot syndrome, GSTP rs1695

INTRODUCTION: In breast cancer, the regimen used for the neoadjuvant and adjuvant nonmetastatic setting is the 4 cycles of Adriamycin and cyclophosphamide(AC) followed by Docetaxel(T), Docetaxel and Carboplatin regimens(T+Ca) and Docetaxel + Trastuzumab(T+Tr) (1,2). METHODS: A prospective open-label observational comparative study to evaluate the incidence of anemia and thrombocytopenia among the three regimens of chemotherapy regimen I AC-T, Regime II AC-T+Ca, Regimen III AC-T+Tr. All enrolled patients received pegfilgrastim/filgrastim. The total number of enrolment of patients in the study was 124 and distributed as 38,40,46 in three regimens respectively. RESULTS: The mean incidence of anemia in the regimen I , regimen II and regimen III in overall 8 cycles, it was 7.1± 1.5, 7.4+1.1, 7.1+1.5 respectively. There was no statistically significant difference in the mean incidence of anemia among the 3 study groups. A total of 109 episodes of thrombocytopenia out of 992 cycles of chemotherapy (10.9%) were observed.The mean incidence of thrombocytopenia in regimen I in the initial 4 cycles was 0.1+ 0.5; in the final 4 cycles, 0.2+ 0.6; and in the overall 8 cycles, 0.3+ 1. There was no statistically significant difference in the mean incidence of thrombocytopenia among the 3 study regimens. CONCLUSION: There was no significant difference in the incidence of anemia among the 3 regimens in the initial 4 chemotherapy cycles, final 4 chemotherapy cycles, or overall 8 cycles of chemotherapy.Among the overall 8 cycles of chemotherapy, there was no statistically significant difference in the mean incidence of thrombocytopenia among the three regimens.

Background: Ipratropium, an anticholinergic medication, holds a significant position in the management of various respiratory disorders. Primarily utilized in the pharmacotherapy of chronic obstructive lung disease and to relieve the symptoms of bronchospasm by acting on the muscarinic receptors of the bronchial smooth muscle by inhibiting the same receptors. This case report aims to highlight the ipratropium-induced bronchospasm in a patient of Chronic Obstructive Pulmonary Disease (COPD). Case Presentation: We present a compelling case of severe bronchospasm occurring in a 65-year-old Indian man following the inhalation of a combination of ipratropium bromide and budesonide. This distressing event was accompanied by a precipitous decline in oxygen saturation, plummeting to as low as 40%. Urgent resuscitation measures were imperative, leading to intubation and ventilatory support to restore the patient to a stable state. Following the initial resuscitation, the patient was transferred to the intensive care unit for further management. Disturbingly, another exacerbation of symptoms ensued during ventilator support subsequent to nebulization with combination of ipratropium and levosalbutamol. Encouragingly, the patient’s condition ameliorated upon discontinuation of the nebulization. Conclusion: This case report illuminates the concerning potential for ipratropium-induced bronchospasm in COPD patients. As we navigate these complexities, the pursuit of safer alternatives like tiotropium takes center stage, reminding us of the continuous evolution in optimizing respiratory therapies. These findings emphasize the significance of vigilant monitoring and tailored interventions in clinical practice.