The Evaluation of Amifostine for Mucosal Protection in Advanced Loco-Regional Squamous Cell Carcinomas of the Head and Neck (SCCHN) Treated with Concurrent Weekly Carboplatin, Paclitaxel, and Daily Radiotherapy (RT)

Systematic review of amifostine for the management of oral mucositis in cancer patients

“…The infusion of 250 mg of amifostine 15 min prior to radiotherapy reduced the severity of oral mucositis in the experimental when compared to the control group, but the difference did not reach significant levels in one, non-blinded, non-placebo-controlled study [9]. Grade 3 oral mucositis was reduced when compared to historical controls (40 versus 70 %) in patients who received 500 mg amifostine within 1 h before radiotherapy [11]. Oral mucositis was significantly lower in severity at all 10 Gy increments except 60 Gy and over in patients who received 300 mg amifostine before radiotherapy when compared with historical controls [39].…”

“…In patients undergoing chemoradiotherapy for head and neck cancer, eight articles were reviewed [4,5,7,9,11,29,30,39 ]. In all eight studies, amifostine was administered for prevention.…”

“…-Amifostine did not reduce oral mucositis [29,30] -Historical controls were used [11,29,39] -Not blinded nor placebo-controlled studies [4,5,7,9] -The diagnostic criteria for oral mucositis not adequately described [30]. -A beneficial effect for the use of amifostine reported in 5 studies [17,19,20,22,23].…”

“…This might possibly prevent the up-regulation of inflammatory pathways related to cancer therapy toxicity and, thus, may allow compliance with the planned treatment regimens while preserving the patient's quality of life. Amifostine, administered intravenously, has been shown to reduce the incidence of acute and late xerostomia in head and neck cancer patients who receive radiotherapy, with or without chemotherapy [4][5][6][7][8][9][10][11][12][13]. The American Society of Clinical Oncology has recommended that the cytoprotective effect of amifostine "may be considered" for the prevention of cisplatin-associated nephrotoxicity, for the reduction of grade 3-4 neutropenia and to decrease acute and late xerostomia with fractionated radiotherapy for head and neck cancer [14,15].…”

“…With regard to oral mucositis, the literature is conflicting with some studies suggesting amifostine to be beneficial in prevention of oral mucositis [4,5,7,11,13,[16][17][18][19][20][21][22][23][24] and some studies suggesting that amifostine does not reduce mucositis prevalence or severity [6,8,10,[25][26][27][28][29][30][31]. Stokman et al performed a meta-analysis of seven studies and reported a positive preventive effect of amifostine on severe oral mucositis [32].…”