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Treatment of anthracycline extravasations using dexrazoxane

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Abstract

Extravasation of cytotoxic agents is a true medical emergency. Dexrazoxane is the only licensed drug for the treatment of anthracycline extravasations. Dexrazoxane proved to be effective and moderately well tolerated. However, alternative approaches for the management of anthracycline extravasations are available such as topical DMSO and cooling. There appears to be general agreement about dexrazoxane usefulness when extravasations involve large volumes of anthracycline and/or central venous access device. Nevertheless, the non-invasive combination of DMSO and cooling is the most commonly described therapy, particularly in small anthracycline extravasations. Further research is still needed to establish unequivocal situations where dexrazoxane must be initiated.

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References

  1. Mullin S, Beckwith MC, Tyler LS. Prevention and Management of Antineoplastic Extravasation Injury. Hosp Pharm. 2000;35:57–74.

    Google Scholar 

  2. Ener RA, Meglathery SB, Styler M. Extravasation of systemic hemato-oncological therapies. Ann Oncol. 2004;15(6):858–62.

    Article  CAS  PubMed  Google Scholar 

  3. Alfaro-Rubio A, Sanmartin O, Requena C, Llombart B, Botella-Estrada R, Nagore E, et al. Extravasation of cytostatic agents: a serious complication of oncological treatment. Actas Dermosifiliogr. 2006;97(3):169–76.

    Article  PubMed  Google Scholar 

  4. Watanabe H, Ikesue H, Yoshida M, Yamamoto N, Sakamoto S, Koga T, et al. Protection against the extravasation of anticancer drugs by standardization of the management system. Hosp Pharm. 2008;43(7):571–6.

    Article  Google Scholar 

  5. Goolsby TV, Lombardo FA. Extravasation of chemotherapeutic agents: prevention and treatment. Semin Oncol. 2006;33(1):139–43.

    Article  CAS  PubMed  Google Scholar 

  6. Reeves D. Management of anthracycline extravasation injuries. Ann Pharmacother. 2007;41(7):1238–42.

    Article  CAS  PubMed  Google Scholar 

  7. Olver IN, Aisner J, Hament A, Buchanan L, Bishop JF, Kaplan RS. A prospective study of topical dimethyl sulfoxide for treating anthracycline extravasation. J Clin Oncol. 1988;6(11):1732–5.

    CAS  PubMed  Google Scholar 

  8. Bertelli G, Gozza A, Forno GB, Vidili MG, Silvestro S, Venturini M, et al. Topical dimethylsulfoxide for the prevention of soft tissue injury after extravasation of vesicant cytotoxic drugs: a prospective clinical study. J Clin Oncol. 1995;13(11):2851–5.

    CAS  PubMed  Google Scholar 

  9. Creus N, Mateu J, Masso J, Codina C, Ribas J. Toxicity to topical dimethyl sulfoxide (DMSO) when used as an extravasation antidote. Pharm World Sci. 2002;24(5):175–6.

    Article  CAS  PubMed  Google Scholar 

  10. Schrijvers DL. Extravasation: a dreaded complication of chemotherapy. Ann Oncol. 2003;14(Suppl 3):iii26–30.

    PubMed  Google Scholar 

  11. Vano-Galvan S, Jaen P. Images in clinical medicine. Extravasation of epirubicin. N Engl J Med. 2009;360(20):2117.

    Article  CAS  PubMed  Google Scholar 

  12. Kane RC, McGuinn WD Jr, Dagher R, Justice R, Pazdur R. Dexrazoxane (Totect): FDA review and approval for the treatment of accidental extravasation following intravenous anthracycline chemotherapy. Oncologist. 2008;13(4):445–50.

    Article  CAS  PubMed  Google Scholar 

  13. Hasinoff BB. The use of dexrazoxane for the prevention of anthracycline extravasation injury. Expert Opin Investig Drugs. 2008;17(2):217–23.

    Article  CAS  PubMed  Google Scholar 

  14. Thougaard AV, Langer SW, Hainau B, Grauslund M, Juhl BR, Jensen PB, et al. A murine experimental anthracycline extravasation model: pathology and study of the involvement of topoisomerase II alpha and iron in the mechanism of tissue damage. Toxicology. 2010;269(1):67–72. doi:10.1016/j.tox.2010.01.007.

    Article  CAS  PubMed  Google Scholar 

  15. Langer SW, Sehested M, Jensen PB. Treatment of anthracycline extravasation with dexrazoxane. Clin Cancer Res. 2000;6(9):3680–6.

    CAS  PubMed  Google Scholar 

  16. Langer SW, Sehested M, Jensen PB. Dexrazoxane is a potent and specific inhibitor of anthracycline induced subcutaneous lesions in mice. Ann Oncol. 2001;12(3):405–10.

    Article  CAS  PubMed  Google Scholar 

  17. Langer SW, Thougaard AV, Sehested M, Jensen PB. Treatment of anthracycline extravasation in mice with dexrazoxane with or without DMSO and hydrocortisone. Cancer Chemother Pharmacol. 2006;57(1):125–8.

    Article  CAS  PubMed  Google Scholar 

  18. Langer SW, Sehested M, Jensen PB, Buter J, Giaccone G. Dexrazoxane in anthracycline extravasation. J Clin Oncol. 2000;18(16):3064.

    CAS  PubMed  Google Scholar 

  19. Bos AM, van der Graaf WT, Willemse PH. A new conservative approach to extravasation of anthracyclines with dimethylsulfoxide and dexrazoxane. Acta Oncol. 2001;40(4):541–2.

    Article  CAS  PubMed  Google Scholar 

  20. Jensen JN, Lock-Andersen J, Langer SW, Mejer J. Dexrazoxane—a promising antidote in the treatment of accidental extravasation of anthracyclines. Scand J Plast Reconstr Surg Hand Surg. 2003;37(3):174–5.

    Article  PubMed  Google Scholar 

  21. El-Saghir N, Otrock Z, Mufarrij A, Abou-Mourad Y, Salem Z, Shamseddine A, et al. Dexrazoxane for anthracycline extravasation and GM-CSF for skin ulceration and wound healing. Lancet Oncol. 2004;5(5):320–1.

    Article  CAS  PubMed  Google Scholar 

  22. Frost A, Gmehling D, Azemar M, Unger C, Mross K. Treatment of anthracycline extravasation with dexrazoxane—clinical experience. Onkologie. 2006;29(7):314–8.

    Article  PubMed  Google Scholar 

  23. Mouridsen HT, Langer SW, Buter J, Eidtmann H, Rosti G, de Wit M, et al. Treatment of anthracycline extravasation with Savene (dexrazoxane): results from two prospective clinical multicentre studies. Ann Oncol. 2007;18(3):546–50.

    Article  CAS  PubMed  Google Scholar 

  24. EMA. Product information: Savene-H-C-682-N-004 (2008) http://www.emea.europa.eu/humandocs/PDFs/EPAR/savene/068206es1.pdf. Accessed 7 Jul 2013.

  25. Tyson AM, Gay WE. Successful experience utilizing dexrazoxane treatment for an anthracycline extravasation. Ann Pharmacother. 2010;44(5):922–5.

    Article  PubMed  Google Scholar 

  26. Conde-Estevez D, Saumell S, Salar A, Mateu-de Antonio J. Successful dexrazoxane treatment of a potentially severe extravasation of concentrated doxorubicin. Anticancer Drugs. 2010;21(8):790–4. doi:10.1097/CAD.0b013e32833d903200001813-201009000-00009.

    Article  CAS  PubMed  Google Scholar 

  27. Arroyo PA, Perez RU, Feijoo MA, Hernandez MA. Good clinical and cost outcomes using dexrazoxane to treat accidental epirubicin extravasation. J Cancer Res Ther. 2010;6(4):573–4. doi:JCanResTher_2010_6_4_573_7708110.4103/0973-1482.77081.

    Article  PubMed  Google Scholar 

  28. Vos FY, Lesterhuis WJ, Bruggemann RJ, Graaf WT. Recovery of symptomatic extravasation of liposomal doxorubicin after dexrazoxane treatment. Anticancer Drugs. 2012;23(1):139–40. doi:10.1097/CAD.0b013e32834be51a.

    Article  PubMed  Google Scholar 

  29. Fontaine C, Noens L, Pierre P, De Greve J. Savene(R) (dexrazoxane) use in clinical practice. Support Care Cancer. 2012;20(5):1109–12. doi:10.1007/s00520-012-1382-2.

    Article  PubMed  Google Scholar 

  30. Muthuramalingam S, Gale J, Bradbury J. Dexrazoxane efficacy for anthracycline extravasation: use in UK clinical practice. Int J Clin Pract. 2013;67(3):244–9. doi:10.1111/ijcp.12103.

    Article  CAS  PubMed  Google Scholar 

  31. Langer SW, Thougaard AV, Sehested M, Jensen PB. Treatment of experimental extravasation of amrubicin, liposomal doxorubicin, and mitoxantrone with dexrazoxane. Cancer Chemother Pharmacol. 2012;69(2):573–6. doi:10.1007/s00280-011-1794-6.

    Article  CAS  PubMed  Google Scholar 

  32. Stanley A. Position Statement on dexrazoxane in the treatment of anthracycline extravasation. The National Extravasation Information Service. UK. 2007. http://www.extravasation.org.uk/Dexrazoxane.htm. Accessed 7 Jul 2013.

  33. Evans L. North Trent Cancer Network—Extravasation Guidelines V4. 2011. http://www.northtrentcancernetwork.nhs.uk/Chemotherapy-Guidelines/Microsoft%20Word%20-%20B-Extravasation%20Guidelines%20v4.pdf. Accessed 6 Jul 2013.

  34. Consortium SM. Re-submission dexrazoxane 500 mg vial of powder for intravenous infusion (Savene®) No. (361/07) TopoTarget A/S. 2008. http://www.scottishmedicines.org.uk/files/dexrazoxane__Savene__Resubmission_FINAL_September_2008.doc_for_website.pdf. Accessed 6 Jul 2013.

  35. BCCA. Prevention and management of extravasation of chemotherapy III-20. 2012. http://www.bccancer.bc.ca/NR/rdonlyres/B10C0DC3-D799-45E8-8A61-A93F00906737/59243/III_20_ExtravasationManagement_1Jun2013.pdf. Accessed 6 Jul 2013.

  36. Anonymous. Dexrazoxane: new indication. Anthracycline extravasation: continue using dimethyl sulfoxide. Prescrire Int 2009;18(99):6–8.

  37. Wengstrom Y, Margulies A, European Oncology Nursing Society Task F. European Oncology Nursing Society extravasation guidelines. Eur J Oncol Nurs. 2008;12(4):357–61.

    Article  CAS  PubMed  Google Scholar 

  38. Pérez Fidalgo JA, García Fabregat L, Cervantes A, Margulies A, Vidall C, Roila F et al. Management of chemotherapy extravasation: ESMO–EONS Clinical Practice Guidelines. Ann Oncol. 2012;23(suppl 7):vii167–vii73. doi:10.1093/annonc/mds294.

  39. Conde-Estevez D, Mateu-de Antonio J. Comment on: management of chemotherapy extravasation: ESMO-EONS clinical practice guidelines. Ann Oncol. 2013;24(4):1128–9; author reply 9–30. doi:10.1093/annonc/mdt021 mdt021.

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The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Pharmacy, Hospital Universitari del Mar. Parc de Salut Mar, Universitat Autònoma de Barcelona, Passeig Marítim 25-29, 08003, Barcelona, Spain

    D. Conde-Estévez & J. Mateu-de Antonio

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  1. D. Conde-Estévez
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  2. J. Mateu-de Antonio
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Correspondence to D. Conde-Estévez.

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Conde-Estévez, D., Mateu-de Antonio, J. Treatment of anthracycline extravasations using dexrazoxane. Clin Transl Oncol 16, 11–17 (2014). https://doi.org/10.1007/s12094-013-1100-7

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  • DOI: https://doi.org/10.1007/s12094-013-1100-7

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