Systematic review on the efficacy of dexrazoxane in managing extravasation of anthracyclines

Introduction Extravasation of anthracyclines is an uncommon but serious complication of systemic anticancer therapy (SACT), potentially causing significant tissue injury, treatment delays and psychological distress. Dexrazoxane is the only licensed pharmacological antidote for anthracycline extravasation; however, its real-world use, dosing adherence and clinical outcomes remain poorly characterised. This systematic review evaluates the clinical efficacy of dexrazoxane, assesses variations in its administration, summarises additional management strategies and describes reported patient outcomes. Research design and methods A systematic search was conducted in MEDLINE, EMBASE and CINAHL for studies published between January 2000 and June 2024. The review protocol was registered with PROSPERO (CRD42024611046). Data extraction captured patient demographics, dexrazoxane use, dosing adherence, surgical interventions, adjunct therapies and outcomes. Risk of bias was assessed using the Joanna-Briggs Institute checklist for case reports. Reporting followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Results Sixteen articles describing 21 individual extravasation cases were included, all were categorised as low risk of bias. Dexrazoxane was administered in all cases; but licensed dosing was followed in only 52% (n=11). Variations included modified schedules, delayed administration and use of unlicensed products. Six patients (29%) required surgery in addition to pharmacological management. No limb loss occurred, and all patients recovered, with recovery ranging from days to months. Seven (33%) resumed SACT post-recovery. The range of adjunctive measures reported across the studies, reflected the absence of standardised extravasation management. Conclusion Significant variation exists in dexrazoxane use and dosing when managing anthracycline extravasation. Given the limited case numbers and heterogeneity, definitive conclusions regarding the efficacy of dexrazoxane cannot be drawn. PROSPERO registration number CRD42024611046