American Society of Clinical Oncology 2008 Clinical Practice Guideline Update: Use of Chemotherapy and Radiation Therapy Protectants

Abstract

Dexrazoxane is not recommended for routine use in breast cancer (BC) in adjuvant setting, or metastatic setting with initial doxorubicin-based chemotherapy. Consider use with metastatic BC and other malignancies, for patients who have received more than 300 mg/m(2) doxorubicin who may benefit from continued doxorubicin-containing therapy. Cardiac monitoring should continue in patients receiving doxorubicin. Amifostine may be considered for prevention of cisplatin-associated nephrotoxicity, reduction of grade 3 to 4 neutropenia (alternative strategies are reasonable), and to decrease acute and late xerostomia with fractionated radiation therapy alone for head and neck cancer. It is not recommended for protection against thrombocytopenia, prevention of platinum-associated neurotoxicity or ototoxicity or paclitaxel-associated neuropathy, prevention of radiation therapy-associated mucositis in head and neck cancer, or prevention of esophagitis during concurrent chemoradiotherapy for non-small-cell lung cancer. Palifermin is recommended to decrease severe mucositis in autologous stem-cell transplantation (SCT) for hematologic malignancies with total-body irradiation (TBI) conditioning regimens, and considered for patients undergoing myeloablative allogeneic SCT with TBI-based conditioning regimens. Data are insufficient to recommend use in the non-SCT setting.

Risk-adapted, treosulfan-based therapy with auto- and allo-SCT for relapsed/refractory aggressive NHL: a prospective phase-II trial

“…14 Patients who received prophylactic treatment with palifermin did not experience grade 4 mucositis, demonstrating the protective effect of this drug. 19 The treatment-related mortality after autologous transplantation (3%) within 30 days compares well with data reported in the literature of patients with lymphoma who have undergone a high- High-dose therapy for relapsed aggressive lymphoma M Koenigsmann et al dose therapy. 20,21 Veno-occlusive disease, which is a risk factor after high-dose BU, 22 was not observed after high-dose TEC in our study.…”

Radiation-induced Cochlea Hair Cell Death: Mechanisms and Protection

“…After several important clinical trials, amifostine was approved by the US Food and Drug Administration and European Medicines Agency. It is recommended for routine use during the treatment to reduce xerostomia in patients with head and neck cancer undergoing RT (Hensley et al, 2009). It also has been widely used in preventing radiation induced mucositis and esophagitis, although the protective effect is still controversial.…”

Serial assessment of toxicity after hematopoietic SCT can discern kinetics of transplant-related organ injury and patterns of recovery

“…The use of serial toxicity assessments may be useful particularly in comparing different reduced intensity transplant regimens and for evaluating strategies or supportive measures employed to reduce the toxicity of HSCT. 7 It was interesting to note in our cohort that the pattern of toxicity appeared to be organ specific, including the onset, timing of peak severity and the kinetics of recovery. In some cases, organ recovery is concomitant with hematopoietic engraftment, …”