Dexrazoxane in children receiving anthracyclines: efficacy, safety, and region-specific considerations for Latin America

BACKGROUND: Anthracyclines are indispensable in paediatric oncology but are associated with well-recognised dose-dependent cardiotoxicity that may result in progressive cardiomyopathy and late heart failure. Dexrazoxane has emerged as a potential primary cardioprotective strategy; however, concerns regarding safety, secondary malignancies, and possible interference with antitumour efficacy have historically limited its widespread adoption. OBJECTIVES: To critically review current evidence regarding the efficacy, safety, and clinical applicability of dexrazoxane in children receiving anthracycline-based chemotherapy, including region-specific implications for Latin America. METHODS: Narrative review of randomised controlled trials, observational studies, systematic reviews, meta-analyses, and international guideline statements evaluating cardiac outcomes, survival, toxicity profiles, and second primary malignancy risk. RESULTS: Dexrazoxane consistently demonstrates cardioprotective effects, including reduced biomarkers of myocardial injury and improved preservation of left ventricular systolic function, particularly among patients exposed to higher cumulative anthracycline doses. Available data indicate no significant adverse impact on relapse rates, event-free survival, or overall survival. Although early studies raised concerns about increased second primary malignancies, subsequent investigations have yielded inconsistent results, leaving residual uncertainty. CONCLUSIONS: Dexrazoxane represents an effective cardioprotective strategy in selected high-risk paediatric patients. A risk-adapted approach balancing cardioprotection, oncologic safety, and healthcare resources is warranted.