Dealing With Chemotherapy Extravasations: A New Technique

Abstract

Doxorubicin, vincristine, and vinblastine are chemotherapeutic drugs commonly used in the treatment of cancer in pets. It takes technical skill to administer these drugs, because they are caustic sclerotics. If doxorubicin is extravasated into the perivascular tissues, the results may be devastating. The attending nurse and clinician must act vigorously to immediately remove every drop of the drug spilled into the tissues. Unfortunately, little has been written on how to effectively do that, but this paper describes an aggressive technique that can be used to combat such a spill.

Lipid peroxidation in rats treated with vincristine sulphate and nandrolone decanoate

“…Adverse effects of vincristine include nonselective cytotoxicity that results in moderate myelosuppression (both erythrocytes and leukocytes), anorexia, intestinal disturbances, alopecia (Nak et al, 2005), necrosis (tissue extravasation) (Villalobos, 2006), peripheral and rarely central toxicity (Whittaker et al, 1973;Hamilton et al, 1991;Cuddon, 2002). If the professional is familiarized with the agent to be applied, its toxicity can be identified and treated early, improving the wellbeing of the animal (Norris and Withrow, 1984;McKnight, 2003).…”

Dexrazoxane treatment of doxorubicin extravasation injury in four dogs

“…Tissue damage progresses over 1 to 3 weeks, leading to deep ulceration and exposure of muscle, tendons, and bone. 9 Research regarding treatment of anthracycline (eg, doxorubicin) extravasation injuries is limited in both human and veterinary oncology. Most of the literature consists of experimental animal studies [10][11][12][13] and case reports.…”

Review of oncological emergencies in small animal patients

“…Many chemotherapeutic agents can induce significant tissue injury if extravasation (EV) of the drug occurs during administration. Examples of such vesicants include commonly used chemotherapy agents such as DOX and the vinca alkaloids (Villalobos ). The exact mechanism behind extravasation injury is not completely understood, but it is thought to be due, at least in part, to tissue damage secondary to free radical formation or damage to DNA.…”

“…Severity ranges from erythema to more serious open draining wounds. Immediate treatment (Table ) includes applying cold packs in the case of DOX and warm packs with the vinca alkaloids (Dorr ; Pattison ; Villalobos ). In cases of DOX EV (Fig.…”

“…In cases of DOX EV (Fig. ), treatments include dimethyl sulphoxide (DMSO) and hyaluronidase (HU) (Villalobos ; Mouridsen et al . ).…”