The management of paclitaxel (Taxol®) extravasation

A. Stanley, S. Marsh

Extravasation-the leakage of a drug from the vascular to the subcutaneous compartment, capable of causing inflammation, pain, swelling and/or necrosis.
This has long been a recognised complication of all intravenous therapy, and particularly cytotoxic administration. As no effective test models exist for this toxicity, it has to occur as a clinical complication of use. This fact presents a significant problem with the development and use of new chemotherapeutic agents.
We report three paclitaxel extravasations which have occurred in the last 20 months. Following aspiration, each patient received subcutaneous dexamethasone and chlorpheniramine into and around the affected area. This was followed by an oral dose of 1 g of sodium cromoglycate. Thirty minutes after initial treatment hyaluronidase 1500 I.U. in 2 ml was injected into the affected area and intermittent warm compression administered.
This acute treatment lasted 24 hours. The patient was then discharged with topical hydrocortisone 1% cream to be applied four times a day.
None of the extravasations resulted in necrosis, although one patient experienced severe pain in the soft tissues and one of the patient's treated areas showed long term discolouration.
The presentation will discuss this rationale for the treatment and the role of the UK National Extravasation database in managing extravasation incidence.

Birmingham Oncology Centre, City Hospital and University of Birmingham Institute for Cancer Studies.

Conference abstracts – JOPP Vol 1 1995