Which extravasation management is recommended for irinotecan?

• A. Topical flushing with sterile water and application of ice
• B. Ice Alone
• C. Hyaluronidase Injections
• D. Totect Infusion

Answer: (A)

Extravasation management is drug-specific, aiming to limit tissue exposure and limit the drug’s spread. For irinotecan, the best local approach is to dilute the remaining drug in tissue and reduce diffusion by cooling. Topical flushing with sterile water helps dilute and wash away any drug that remains in the tissue, while applying ice causes vasoconstriction to further limit spread. There is no dedicated antidote for irinotecan like there is for some other agents; dexrazoxane (Totect) is reserved for anthracyclines, not irinotecan. Hyaluronidase injections are used for certain other drugs to aid dispersion but are not standard for irinotecan extravasation. Therefore, the combination of sterile-water flushing and cooling is the recommended management.