Use of cardioprotective dexrazoxane and myelotoxicity in anthracycline-treated soft tissue sarcoma patients.

Abstract

11053 Background: Dexrazoxane (DEX) is indicated as a cardioprotective agent for patients receiving doxorubicin, who are at increased risk for cardiotoxicity. Concerns have been raised on the use of DEX, particularly in the adjuvant setting, because of the risk of interference with the antitumor effect of doxorubicin. Two meta-analyses in metastatic breast cancer have rejected this hypothesis, but have shown an apparent increase in the severity of myelosuppression when DEX is used. No data in soft-tissue sarcoma (STS) patients is available, so far. Here, we retrospectively analyzed a cohort of our Institute database to assess whether the addition of DEX causes more bone marrow suppression in STS patients receiving Anthracycline-Ifosfamide (AI) combination in perioperative and advanced setting. Methods: 133 patients who received AI between January 2006 and December 2017 were included. 46 of them received DEX concurrently with the AI treatment. Hospital records were reviewed and available for all patients (the accessibility of all the data was an inclusion criterion). Compared to the non-DEX group, patients who received DEX were more frequently treated in the context of a perioperative setting (respectively 27.3 vs 38.8%). No other differences in terms basal patient features were recorded. Significantly, all patients received similar post-medication after each cycle. Results: Compared with the non-DEX group, DEX treatment was associated with significantly higher rates of G3/4 hematological side effects: leucopenia (28.7 vs 56.5%, p value=0.0014); neutropenia (35.6 vs 69.6%, p value=0.0002); anemia (28.7 vs 41.3%, p value=0.1758); thrombocytopenia (32.1 vs 54.3%, p value=0.0159). Similarly, compared to the non-DEX group, there were more hospitalizations for febrile neutropenia (37.9 vs 63.0%, p value=0.0066) and dose reductions (19.5 vs 39.1%, p value=0.0221) in the DEX group, above all in perioperative setting (15.6 vs 58.3%, p value=0.0085); but no significant difference in the incidence of treatment delays or interruption. Conclusions: Adding DEX to Anthracycline-based chemotherapy in soft-tissue sarcoma patients leads to higher rates of bone marrow suppression in all blood components, as well as more febrile neutropenia events, and dose reductions.