Nanosponge Formulation for the Encapsulation of Molnupiravir: Evaluation of Sustainable Oral Capsule Delivery

Abstract

Colorectal cancer (CRC) care involves complex regimens and polypharmacy, creating substantial risks for drug-related problems (DRPs) and adverse drug reactions (ADRs). We conducted a cross-sectional retrospective review of consecutive adults with CRC who received systemic anticancer therapy at a tertiary center from 01 December 2024 to 31 July 2025 (N=240; adjuvant n=108; metastatic n=132; median age 59 years; 61% male). Drug utilisation was evaluated against NCCN guidance; relative dose intensity (RDI) and on-time delivery were calculated, supportive care appropriateness (antiemetics, primary GCSF) was assessed, DRPs were coded using PCNE v9.1, and ADRs were graded by CTCAE v5.0 with Naranjo, Hartwig, and Schumock–Thornton assessments. Guideline-concordant regimen choice was high (adjuvant 92%; metastatic 82%). Median RDI was 90% (IQR 82–97) in adjuvant therapy and 86% (78–95) in metastatic therapy; proportions achieving RDI ≥85% were 68% and 60%, respectively. On-time cycle delivery occurred in 74% (adjuvant) and 69% (metastatic). Antiemetic prophylaxis was appropriate in 91% and 88%; primary G-CSF use when indicated was 80% and 77%. DRPs averaged ~2 per patient, led by monitoring/documentation/duplication issues (29%), effectiveness problems (28%; dose calculation/organ-function adjustment), and clinically relevant drug–drug interactions (24%). Any-grade ADRs occurred in 77.9% and grade ≥3 in 22.1%; notable events included nausea/vomiting grade ≥2 (32.1%), mucositis ≥2 (15.8%), neuropathy ≥2 (27.9%), diarrhea ≥3 (9.2%), hand–foot syndrome ≥2 (14.2%), neutropenia ≥3 (17.9%), thrombocytopenia ≥3 (7.1%), and anemia ≥3 (7.9%). Preventable ADRs comprised 29.9%. These findings support targeted pharmacistled interventions to strengthen monitoring, optimize dosing, mitigate interactions, and sustain RDI to improve safety and effectiveness in CRC treatment.