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

Anthracycline use is associated with cardiotoxicity. Dexrazoxane may prevent anthracycline-associated cardiotoxicity, yet its adoption remains inconsistent due to concerns about oncologic interference and myelosuppression.

A systematic review was conducted following PRISMA guidelines (Prospero: CRD420251039900). Medline, Embase, Central, Web of Science, and Scopus were searched from inception to December 2025. Both randomised and observational studies reporting on the effects of dexrazoxane on risk of clinical heart failure (HF) and left ventricular ejection fraction (LVEF) decline, oncologic outcomes (objective response, overall survival, progression-free survival), and hematologic toxicities (anemia, neutropenia, thrombocytopenia) in adults receiving anthracycline-based chemotherapy were included. Random-effects meta-analyses were performed, stratified by study design. Certainty of evidence was assessed according to GRADE.

Sixteen studies (n = 3996) were included. Based on moderate certainty randomised trial evidence, dexrazoxane likely reduces clinical HF (relative risk [RR] 0.23, 95% confidence interval [CI] 0.10-0.51) with no difference in neutropenia (RR 1.04, 95% CI 0.98-1.11). Based on low-certainty randomised trial evidence, dexrazoxane may reduce LVEF decline (RR 0.38, 95% CI 0.26-0.54) with little to no difference in objective response (RR 0.91, 95% CI 0.80-1.04), anemia (RR 1.44, 95% CI 1.19-1.75), and thrombocytopenia (RR 0.89, 95% CI 0.65-1.24). Evidence was uncertain regarding the effect on overall and progression-free survival.

Dexrazoxane was associated with a lower risk of clinical HF and LVEF decline without significant differences in cytopenias or oncologic response. However, the certainty of evidence was limited. Further research in contemporary cardio-oncology should focus on non-breast cancer populations, standardise outcome definitions, and evaluate alternative dosing regimens.