Dexrazoxane

Dexrazoxane (Zinecard) was approved in May 1995 to reduce the incidence and severity of doxorubicin cardiomyopathy in women with metastatic breast cancer who have received a cumulative 300 mg/m2 and will continue doxorubicin, on randomised trials that markedly reduced cardiac events; it is not used from the start of treatment because of an early signal of reduced response, later not confirmed. Totect was approved in 2007 for anthracycline extravasation, given within six hours on three consecutive days, on two single-arm European studies in which surgery was avoided in the great majority. Dexrazoxane is also used in paediatric leukaemia and lymphoma protocols to protect against late cardiotoxicity, an area where long-term Children's Oncology Group follow-up has been reassuring about secondary malignancy. Myelosuppression adds to that of chemotherapy.