Extravasation of combination regimens of vesicant drugs
Abstract:
Introduction: Extravasation of vesicant chemotherapy is an oncological emergency that may result in severe tissue injury, functional impairment, and long-term morbidity. Management becomes particularly challenging in combination regimens containing agents with different vesicant properties and opposing treatment recommendations.
Case Report: We report a fatal case associated with administration of a combination chemotherapy regimen through difficult peripheral venous access. Mild symptoms during infusion of a non-vesicant agent led to suspected extravasation; consequently, antidotes were not administered. The patient was initially discharged without clinical signs of injury. However, subsequent presentation revealed severe local damage attributed to extravasation of vesicant agents within the regimen.
Management & Outcome: Clinical assessment suggested injury secondary to extravasation of vesicant agents previously administered within the regimen, most likely doxorubicin and/or vincristine. Despite hospital admission and multidisciplinary management involving haematology, dermatology, and plastic surgery teams, the lesion progressively deteriorated. The patient died from the resulting complications.
Discussion: This case highlights key challenges in combined chemotherapy regimens, where identification of the causative agent may be uncertain and management strategies differ substantially. It underscores the importance of appropriate vascular access in high-risk patients, early suspicion of vesicant involvement regardless of infusion sequence, and adherence to updated guidelines. Strengthening institutional protocols and decision-support tools is essential to prevent catastrophic outcomes.
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Reference:
Jiménez-Heredia M, Riu-Viladoms G, Carcelero-San Martín E, Monge-Escartín I, Gómez-Pérez B. Extravasation of vesicant drugs in combined regimens: A case with a fatal outcome. J Oncol Pharm Pract. 2026 Oct 8:10781552261494204. doi: 10.1177/10781552261494204. Epub ahead of print. PMID: 42847519.