The application of anthracyclines in anticancer therapy may result in accidental extravasation injury and can be a serious complication of their use. Tissue necrosis with skin ulceration is a possible outcome in the inadvertent extravasation of anthracyclines during intravenous administration. Until recently, there has been no effective treatment against the devastating effect of extravasated anthracycline. Preclinical and clinical studies are leading to the clinical implementation of dexrazoxane as the first and only proven antidote in anthracycline extravasation. In two multicenter studies dexrazoxane has proven to be highly effective in preventing skin necrosis and ulceration. This review focuses on the development and management of dexrazoxane in anthracycline extravasation injuries.

Complete protection from nausea/vomiting is currently achieved in a minority of patients receiving high-dose chemotherapy (HDC). Currently the use of 5-HT 3 -antagonists and dexamethasone (DEX) represents the standard of care. The role of the NK-1-antagonist aprepitant in HDC remains to be better defined. A total of 64 patients undergoing multiple days of HDC received granisetron, DEX plus aprepitant during chemotherapy. After the end of chemotherapy aprepitant plus DEX was given for a further 2 days. Primary end point was CR defined as no vomiting and no use of rescue medication in the overall phase (day 1 until 5 days after end of chemotherapy). Acute/delayed and overall CR were achieved in 83%/70% and 63%, respectively. Acute and delayed nausea were observed in 20 and 38% of the patients. The tolerability of the aprepitant regimen over 4-5 days was comparable with the 3-day antiemetic regimen. In our study, aprepitant demonstrated good tolerability. Taking into account the methodological constraints of comparing our results with those from the available literature, the addition of aprepitant to the antiemetic treatment regimen may provide improved prevention of chemotherapy-induced nausea and vomiting during HDC.

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Totally implantable venous access ports have been in use now for over 20 years. They are valuable instruments for long-term intravenous treatment of patients with cancer. Apart from perioperative difficulties, the typical complications associated with venous access ports are venous thrombosis, port infection, extravasation, pinch off syndrome, dislocation, occlusion and catheter leakages. The vast majority of these complications are avoidable, or at least the complication rate can be reduced with health care personnel training and education of patients. This review will give a broad overview on the frequency and possible complications related to port devices. Furthermore, this review suggests strategies for management including proposals to avoid such complications.