Treatment of anthracycline extravasation with Savene (dexrazoxane): results from two prospective clinical multicentre studies

Abstract

Dexrazoxane proved to be an effective and well-tolerated acute treatment with only one out of 54 assessable patients requiring surgical resection (1.8%).

Describing Intravenous Extravasation in Children (DIVE Study)

“…Prospective human clinical trials have been conducted for antidotes to address extravasation due to chemotherapy medications, but these clinical trials have been limited to adults, and evidence is lacking for use of these antidotes in the pediatric population. 10,11 The objectives of this study were to describe the incidence of extravasations (as the rate per patient-days) at the authors' institution, to identify the agents causing extravasation injuries, to describe the use of antidotes to manage the identified extravasations, and to assess the appropriateness of antidote use. The secondary objective was to describe adverse reactions to the antidotes administered.…”

Managing Vesicant Extravasations

“…Topical cooling, such as ice packs, should be removed for at least 15 minutes prior to, and during, Totect treatment. The patient should be monitored for side effects, including nausea/vomiting, diarrhea, stomatitis, bone marrow suppression, elevated liver enzyme levels, and infusion site burning [12][13][14]. Mechlorethamine (nitrogen mustard) extravasations have been and continue to be treated with the antidote sodium thiosulfate.…”

Management of Anthracycline Extravasation Injuries

“…9,11 Most recently, the results of 2 international studies were reported. 13 Both were European multicenter, open-label, single-arm trials. Patients (N = 17 and N = 36) were included if they had developed anthracycline (ie, epirubicin, doxorubicin, or daunorubicin) extravasation proven by fluorescence-positive tissue biopsy.…”

“…Although these studies were small, their results significantly add to existing data supporting the use of dexrazoxane in anthracycline extravasation. 13 Based on animal studies, case reports, and 2 prospective Phase II/III trials, dexrazoxane is a promising agent for the treatment of anthracycline extravasation. Currently, dexrazoxane is available in the US in 250-and 500-mg vials and is approved for prophylaxis of anthracyclineinduced cardiomyopathy.…”

“…13 However, tissue necrosis was attributed to the use of dexrazoxane in one case report in which the patient was receiving cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) in addition to dexrazoxane for the treatment of non-Hodgkin's lymphoma. 29 During the dexrazoxane infusion, the patient experienced pain at the infusion site without evidence of extravasation and subsequently developed tissue necrosis necessitating recurrent skin grafts.…”