Dexrazoxane for Cardioprotection During Anthracycline Therapy: A Systematic Review and Meta-Analysis

Area of Science:

• Cardio-oncology
• Pharmacology
• Hematology

Background:

• Anthracycline chemotherapy is linked to cardiotoxicity.
• Dexrazoxane is a potential cardioprotective agent, but its use is limited by concerns over cancer treatment efficacy and bone marrow suppression.

Purpose of the Study:

• To systematically review the evidence on dexrazoxane's efficacy and safety in preventing anthracycline-associated cardiotoxicity.
• To evaluate its impact on oncological outcomes and hematological toxicities.

Main Methods:

• A comprehensive systematic review and random-effects meta-analysis of randomized and observational studies.
• Searches included major databases (MEDLINE, EMBASE, CENTRAL, Web of Science, Scopus) up to December 2025.
• Outcomes assessed included clinical heart failure (HF), left ventricular ejection fraction (LVEF) decline, oncological response, and hematological toxicities.

Main Results:

• Dexrazoxane significantly reduced clinical HF (moderate certainty evidence) and LVEF decline (low certainty evidence).
• No significant differences were observed in neutropenia, objective response, or thrombocytopenia.
• Evidence for anemia was conflicting, and effects on overall and progression-free survival remain uncertain.

Conclusions:

• Dexrazoxane appears to reduce cardiac risks associated with anthracyclines without compromising oncological outcomes or significantly increasing cytopenias.
• The certainty of evidence is limited, highlighting the need for further research.
• Future studies should focus on diverse cancer populations, standardized definitions, and alternative dosing strategies in cardio-oncology.