Successful dexrazoxane treatment of a potentially severe extravasation of concentrated doxorubicin

Abstract

Dexrazoxane is now authorized for the treatment of anthracycline extravasations. Several clinical cases of doxorubicin extravasation treated with dexrazoxane have been reported to date, but detailed cases have not been published. We report a case of a successful dexrazoxane treatment for a potentially severe extravasation of concentrated doxorubicin. We also describe objective outcome of this treatment, drug tolerance to dexrazoxane and long follow-up. A 29-year-old man diagnosed with Hodgkin's lymphoma was prescribed a regimen including 90 mg of doxorubicin in a 50 ml infusion using a reduced occlusion infusion pump. After this infusion, the patient complained of pain around the site of injection and presented a 10x6-cm swollen area with erythema and inflammation. A significant portion of doxorubicin was extravasated. Dexrazoxane was prescribed as an antidote. Side effects of dexrazoxane were restricted to reversible hematological toxicity, nausea, and vomiting. The next day, the inflammation of the extravasation area was reduced. On day 7, a painless mild induration in the extravasated area was the only remaining sign of the extravasation. On day 40, an arm nuclear magnetic resonance image showed no focal injuries. At 6-month follow-up, the patient has no sequelae. The two risk factors that could have increased the severity of the extravasation are the use of an infusion pump and the high drug concentration. Dexrazoxane proved to be effective and moderately well tolerated. A dexrazoxane stock in oncological facilities could help to promptly handle emergencies like this. Anthracyclines can be administered using reduced occlusion infusion pumps, but it seems preferable to always administer a free-running infusion to minimize accidents like this one.

Dexrazoxane efficacy for anthracycline extravasation: use in UK clinical practice

“…These data have since been supported by several case reports/series (). In the largest of these by far, involving 41 anthracycline extravasation adult patients, Fontaine et al.…”

“…These data have since been supported by several case reports/series (16)(17)(18). In the largest of these by far, involving 41 anthracycline extravasation adult patients, Fontaine et al showed that surgical debridement was avoided in 95% (39/41) of cases following Savene ® treatment, in 93% (26/28) of extravasation from a central venous access device and 73% of patients continued with their planned chemotherapy schedule (18).…”

“…To date, there have been eight published trials or case studies (15)(16)(17)(18)(19)(20)(21)(22) reporting a total of 102 cases of Savene ® use. Because of the severity of an anthracycline extravasation, it would be viewed unethical to compare it to placebo and as there is no other licensed product available for the treatment of anthracycline extravasations, no active comparative studies have been undertaken.…”

Textbook of Plastic and Reconstructive Surgery

“…Cytotoxic agents -Cause direct cell injury. Doxorubicin is the agent most commonly reported to cause tissue necrosis (Conde-Estevez et al, 2010).…”