Which antidotes are used for extravasation of anthracyclines and vinca alkaloids, respectively?

• A. Dexrazoxane for anthracyclines; hyaluronidase for vinca alkaloids.
• B. Hyaluronidase for anthracyclines; dexrazoxane for vinca alkaloids.
• C. Sodium thiosulfate for both.
• D. No antidote available.

Answer: (A)

Extrafascination injuries from chemotherapy are treated with antidotes that counteract the specific drug’s tissue-damaging effects. For anthracyclines, the damage is driven by iron-catalyzed free radical formation in local tissues. Dexrazoxane acts as an iron chelator, reducing those free radicals and protecting the tissue, so it’s the standard antidote when an anthracycline extravasates.

For vinca alkaloids, the injury comes from the drug’s local cytotoxic effects on cells in the surrounding tissue. Hyaluronidase helps by breaking down hyaluronic acid in the extracellular matrix, which spreads the drug more evenly and lowers the peak concentration at any one spot, thereby mitigating localized tissue necrosis. That makes hyaluronidase the appropriate antidote for vinca extravasation.

Sodium thiosulfate isn’t used as the antidote for these drugs, and the notion that there is no antidote is incorrect because there are established interventions specific to these agents.