Anthracycline extravasation treatment information

You will have been given this part of the patient information leaflet if one of the chemotherapy drugs you are having is an Anthracycline and it has extravasated. For an explanation of extravasation please see the separate leaflet ‘Looking after my skin following a Chemotherapy leak’.

What is Anthracycline chemotherapy?

Chemotherapy drugs are classified into categories depending on their potential to cause damage to veins and surrounding tissues should an extravasation occur. Anthracycline chemotherapies have a very strong ability to bind to the DNA in your cells which is why they are such an important choice in treating cancers. However this means that the risk of tissue damage when they leak is greater. Anthracycline drugs Cambridge University Hospitals (CUH) currently use;

• Doxorubicin
• Epirubicin
• Daunorubicin
• Idarubicin
• Mitoxantrone

Is an ‘Anthracycline’ extravasation always a serious problem?

This is dependent on two main factors:

• How much of the drug has leaked out.
• How quickly the leakage is recognised.

The nurses administering your chemotherapy are trained to be aware and spot the signs of an extravasation quickly and be able to commence appropriate treatment as soon as possible. The answers to the above questions will determine what further treatment you will need. The aim of the treatment is referred to as localise and neutralise this will take the form of:

• Applying a cold compress to cause vasoconstriction, to localise the drug to remain within the affected area
• Application of topical DMSO liquid at the site.
• Review by the Plastic surgery team who will explain to you if further intervention is required

Topical DMSO treatment (Dimethyl Sulfoxide)

What is topical DMSO?

Topical DMSO is a liquid that can be used to prevent ulceration/skin breakdown following an Anthracycline extravasation. It has the ability to penetrate tissue when applied topically and has the capacity to speed up the removal of extravasated drugs from the tissue.

If the amount of chemotherapy drug that has extravasated was <3mls and your skin remains intact you can be given a course of topical DMSO to apply to the affected area. Topical DMSO liquid will be applied as soon as possible post extravasation and treatment will continue for seven days.

• DMSO should be applied every two hours after initial application for the first 24 hours.
• DMSO should then be applied every six hours for seven days.
• Alongside this you will be given a steroid cream, hydrocortisone 1% cream, initial application should take place three hours after initial DMSO application and then continue every six hours for seven days.
• This should lead to alternate applications of DMSO and Hydrocortisone every three hours.
• Care should be taken to only apply the solution to the affected area and to minimise contact with healthy skin.
• There is a small risk of redness and blistering occurring if contact made with healthy skin.
• After completion of the eight day course you should attend for a review of your hand/arm either with your consultant team or in the Cancer Assessment Unit.

Missed applications of DMSO or hydrocortisone cream

If you miss an application for any reason, if more than an hour has passed it is best to miss that application and apply the next application at its due time.

First 24 hours

DMSO was first applied in the hospital at …………………………… (Time)

Subsequent days

Topical steriod to be applied every 6 hours from time at +45hr.

Topical DMSO to be applied every 6 hours from time at +48hrs.

This results in topical administration, alternately, every three hours.