Key result
Dexrazoxane with doxorubicin shows no EF benefit but is linked to Grade 4 anemia and neutropenia.
Why the study?
Although dexrazoxane is used to prevent doxorubicin-induced cardiotoxicity, its capacity to mitigate cardiotoxicity and concomitant toxicities in patients actively receiving doxorubicin required further evaluation.
Does the addition of dexrazoxane to doxorubicin prevent ejection fraction decline in patients with malignancy?
Cohort (n=152)
No
Does the addition of dexrazoxane to doxorubicin prevent ejection fraction decline in patients with malignancy?
Absolute Event Rate: -0.7% vs -2%
p-value: p=0.9174
The addition of dexrazoxane to doxorubicin did not significantly preserve ejection fraction during the short-term treatment window but was associated with increased high-grade hematologic toxicity.
Does not support adding dexrazoxane to doxorubicin for ejection fraction preservation; leaves open whether benefits outweigh increased hematologic toxicity in randomized trials.
Introduction: Dexrazoxane (DZR) has been used to prevent cardiotoxicity from doxorubicin (DOX), particularly in younger patients with cancer and those with pre-existing cardiac dysfunction. Herein, we sought to further define the role of DZR by evaluating its capacity to mitigate cardiotoxicity in patients actively receiving DOX, while also assessing concomitant toxicities. Materials and methods: We conducted a retrospective, propensity-matched cohort study at a single academic center, comparing outcomes between patients treated with DZR plus DOX and those who received DOX alone. Patients were matched by age, sex, and cumulative lifetime dose of DOX. Cardiotoxicity was assessed as the change in ejection fraction (EF) during and after treatment. To evaluate associations between DZR and other toxicities, we utilized the Common Terminology Criteria for Adverse Events, Version 5 (CTCAE). Results: (ranges 75-525 and 75-600), respectively. Patients were followed up with their last measured EF at a median of -3 and 18.5 days after their final DOX dose, respectively. The median change in EF was -2% in the DOX alone group and -0.7% in the DOX + DZR group (p = 0.9174). Grade 4 anemia occurred in 16 patients in the DOX alone group and in 41 patients in the DOX + DZR group (p = 0.0002). Similarly, grade 4 neutropenia was observed in 15 and 50 patients, respectively (p = 0.0013). Discussion: The addition of DZR to DOX did not result in a statistically significant change in EF during the treatment window. Given the limitations of the dataset, this may suggest a lack of substantial immediate benefit from the co-administration of DZR with DOX. An increased rate of high-grade neutropenia and anemia was observed in patients receiving the combination, although this may be due to confounding factors. Further analysis is warranted, ideally through larger multi-institutional or prospective studies.
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Neiman et al. (2025) conducted a cohort in Cancer (malignancy) (n=152). Dexrazoxane plus Doxorubicin vs. Doxorubicin alone was evaluated on Change in ejection fraction (EF) (p=0.9174). The addition of dexrazoxane to doxorubicin did not significantly change ejection fraction compared to doxorubicin alone (median change -0.7% vs -2.0%, p=0.9174), but increased Grade 4 anemia and neutropenia.
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