Antineoplastic extravasation management: Consensus of the Spanish Oncology Pharmacy Group (GEDEFO)

Abstract

Objective

To review and reach a consensus of the pharmacological and non-pharmacological measures to manage antineoplastic extravasation and specific measures recommended for each antineoplastic agent; and to propose a flow chart to manage extravasations.

Methods

The panel of experts comprised 8 oncology pharmacists of the Spanish Oncology Pharmacy Group (GEDEFO), 2 served as coordinators. From October 2019 to March 2020 panellists reviewed and discussed extravasation measures management, tables of antineoplastic with recommended measures, and algorithms of interventions in case of extravasation suspicion, based on 8 reference documents and literature published. Coordinators produced a draft document and suggested initial proposals that were reviewed independently by panellist who sent back agreement and comments. A second draft was sent and discussed by a consensus meeting. Finally, the definitive recommendations were individually approved by all members.

Data Summary

Specific pharmacological treatments (antidotes) included topical dimethyl-sulfoxide, subcutaneous hyaluronidase and intravenous dexrazoxane; and non-pharmacological measures included local dry cold and heat, and light exposure prevention. Dosage and administration guidelines, special precautions/remarks, and contraindications relevant for optimal management and patient information were provided. The specific measures and recommendations for 71 antineoplastic agents were summarised. A proposal of immediate multidisciplinary sequence of interventions following an extravasation was presented.

Conclusions

This consensus of experts standardises pharmacological and non-pharmacological measures, recommends specific measures for each antineoplastic agent, updates the number of drugs included and provides a practical sequence of actions to be implemented in case of a suspicion of extravasation, facilitating the decision-making process and reducing variability of extravasations management.