Background Extravasation of cytostatic agents is one of the major complications in cancer treatment with anthracyclines. There is a lot of information about the management of extravasations with ‘classical’ anthracyclines but liposomal anthracyclines have distinctive pharmacokinetics and a different toxic-effect profile. Currently, dexrazoxane is only licensed to treat extravasation with ‘classical’ anthracyclines. However, the efficacy of desrazoxane has been reported in some cases reports. This review collects all extravasation cases that have been published with liposomal and pegylated liposomal anthracyclines, with special emphasis on the use of dexrazoxane.
Purpose To review the scientific literature on the development and managenement of anthracycline extravasation injuries, including clinical evidence for desrazoxane.
Material and methods A bibliographic review was conducted using the Pubmed database with the following keywords: antracyclines, extravasations and chemotherapy. The period covered was from database inception to September 2015, inclusive. Articles about clinical cases and literature in English or Spanish were included. Practice guidelines and expert consensus were also analysed.
Results Practice guidelines and expert consensus were not found. 7 articles fulfilled the inclusion criteria: 5 cases reports (including 6 patients) and 2 series of cases (each series treated in the same way).
Extravasated drugs: 3 liposomal doxorubicin, 1 liposomal daunorubicin and 4 pegylated liposomal doxorubicin. General therapy: local cold packs, topical and subcutaneous corticosteroids, painkillers, subcutaneous lidocaine and low weight molecular heparin. Desrazoxane was administered in 3 cases but only 1 article reported the dosage. Symptoms: local oedema, pain, burning, erythema and haematoma. Outcome: only 1 patient treated with local cold packs and washing had necrotic areas and scars; the rest of the cases completely resolved in 2 or 3 months with no skin injury. Since 2006, the date of approval of desrazoxane, 3 of 4 reported cases have been treated with this medicine.
Conclusion There is a lack of consensus in the management of extravasations with liposomal anthracyclines, and desrazoxane could be used to treat severe extravasations of liposomal anthracyclines. Therefore, the introduction of this antidote for this medicine needs further study to ensure its efficacy and safety. Hence all oncology services should make a protocol including general interventions and the off-label use of this medicine.
No conflict of interest.
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