Dexrazoxane for anthracycline extravasation and GM-CSF for skin ulceration and wound healing

Abstract

A 38-year-old woman with breast cancer and a right partial mastectomy was given adjuvant chemotherapy according to the protocol of a clinical trial by the Breast Cancer International Research Group, called BCIRG 005. This multicentre phase III randomised trial is designed to compare treatment with docetaxel in combination with doxorubicin and cyclophosphamide with treatment with doxorubicin and cyclophosphamide followed by docetaxel as a adjuvant therapy for patients with operable breast cancer who are HER2-negative with positive axillary lymph nodes. Our patient was randomised to receive four cycles of doxorubicin and cyclophosphamide followed by four cycles of docetaxel. A port-a-cath polysite catheter was inserted into her left subclavian vein before administration of the fourth cycle of chemotherapy. During treatment, the patient accidentally received a massive doxorubicin extravasation. Halfway through doxorubicin administration, the patient complained of pain and swelling. The nurse noted tenderness and swelling around the port-a-cath entrance and immediately stopped the infusion. The Huber needle was dislodged and the region surrounding the port-a-cath was red, painful, and swollen. There was definite extravasation: half the doxorubicin dose had been infused and most of this had extravasated. Within 1 h we infused 1500 mg of dexrazoxane over 15 min through a peripheral line to avoid severe tissue necrosis of the left wall of the chest. Pain and tissue tension were relieved immediately. 5 h after extravasation, we administered a further 1500 mg of dexrazoxane. The patient improved and there were no signs of immediate tissue damage. 24 h later, a final 750 mg of dexrazoxane was given resulting in a total dose of 3750 mg. Because the patient's surface area was 1·8 m 2 Shamseddine AI Khalil AM Kibbi AG et al. Granulocytemacrophage colony-stimulating factor for treatment of chemotherapy extravasation. Eur J Gynaecol Oncol. 1998; 19: 479-481 PubMed Google Scholar , the dose received was therefore 1043 mg/m 2 Shamseddine AI Khalil AM Kibbi AG et al. Granulocytemacrophage colony-stimulating factor for treatment of chemotherapy extravasation. Eur J Gynaecol Oncol. 1998; 19: 479-481 PubMed Google Scholar once a day for 2 days. No cold compress was applied to avoid vasoconstriction and interference with diffusion of dexrazoxane. No immediate systemic side-effects of dexrazoxane were noted. We also started to apply dimethyl sulfoxide to the skin every 6 h. After three doses, application was stopped because the skin became red and the tissue swelled. Tests on liver function remained within normal limits over the next 8 weeks. Neither leucopenia nor thrombocytopenia occurred. The figure (panel shows the site 1 week after the incident.