An investigation of the use of dexrazoxane as a cardioprotectant in UK Teenage and Young Adult (TYA) Cancer Centres

ABSTRACT

Introduction: Around 1 in 10 childhood cancer survivors who receive an anthracycline develop a symptomatic cardiac event over time.1 Dexrazoxane, a free radical scavenger, has been shown to reduce surrogate markers of cardiac damage in children and young people receiving anthracycline chemotherapy.2 In February 2020, NHS England (NHSE) published a new clinical commissioning policy entitled “Dexrazoxane for preventing cardiotoxicity in children and young people (under 25 years) receiving high-dose anthracyclines or related drugs for the treatment of cancer”.1 Given uncertainties regarding the robustness of the supporting data,1,2 a general unfamiliarity with the product and the timing of the publication of the policy (at the start of the COVID-19 pandemic) we hypothesised that these factors may all have impacted on the speed and degree of its adoption. Consequently we decided to undertake a survey of practice, with the aim of exploring awareness of the policy and use of the drug amongst UK TYA centres. Methods: A short questionnaire was designed using the www.onlinesurveys.ac.uk platform. The questionnaire was sent electronically to senior oncology/ haematology pharmacists from all 17 TYA Cancer Centres in the UK in March 2021 and was kept open for six weeks to allow centres sufficient time to respond. Responses were transferred to Microsoft Excel for data analysis. Results: Responses were received from all 17 UK TYA centres. All centres in England (n=13) were either very aware (69%) or somewhat aware (31%) of the dexrazoxane commissioning policy. The majority (three out of four) of the centres from the devolved nations were unaware of the policy. Five centres (29%) had used dexrazoxane as a cardioprotectant since February 2020 and a further five centres (29%) were considering its use. Reasons for not using the drug included unconvinced by efficacy data (n=4), concerned re short and long-term side effects (n=3). Of those centres that had used the drug, three had only given it to 1-3 patients, one centre had given it to 7-9 patients and one centre had given it to >9 patients. None of the centres had a TYA Unit policy or guideline for the use dexrazoxane as a cardioprotectant, although two were in the process of writing one. Furthermore, although stipulated in the commissioning policy, only three out of five centres using the drug required MDT discussion prior to use. From a clinical perspective, there was a lack of consensus as to when in the treatment pathway to start the drug (i.e. with cycle one of chemotherapy or when a threshold dose had been reached). And from a practical perspective, concerns were raised about the short shelf-life of dexrazoxane and the workload implications for aseptic units. Conclusions: Despite generally good awareness of the dexrazoxane commissioning policy, use of the drug by TYA centres has been limited to date and clinical practice has not uniformly matched the recommendations contained within the policy. Further work is required to explore reasons for the slow and variable uptake and to also investigate potential differences in practice between TYA and paediatric centres.