Published in Journal of Clinical Oncology, Vol 27, No 1 (January 1), 2009: pp. 127-145

Martee L. Hensley, Karen L. Hagerty, Tarun Kewalramani, Daniel M. Green, Neal J. Meropol, Todd H. Wasserman, Gary I. Cohen, Bahman Emami, William J. Gradishar, R. Brian Mitchell, J. Tate Thigpen, Andy Trotti, III, Daniel von Hoff, Lynn M. Schuchter

Purpose: To update a clinical practice guideline for chemoprotectant/radioprotectant use in cancer patients.

Methods: An Update Committee reviewed an updated systematic review of the literature since 2002.
Results: Thirty-nine reports met the inclusion criteria: palifermin and dexrazoxane, 3 reports (2 studies) each; amifostine, 33 reports (31 studies); mesna, no published randomized trials identified since 2002.

Recommendations: Dexrazoxane: 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 >300 mg/m2 doxorubicin who may benefit from continued doxorubicin-containing therapy. Cardiac monitoring should continue in patients receiving doxorubicin. Amifostine: may be considered for prevention of cisplastin-associated nephrotoxicity, reduction of grade 3-4 neutropenia (alternative strategies are reasonable), and to decrease acute and late xerostomia with fractionated radiotherapy alone for head and neck cancer (HNC). Not recommended for protection against thrombocytopenia, prevention of platinum-associated neurotoxicity or ototoxicity or paclitaxel-associated neuropathy, prevention of radiotherapy-associated mucositis in HNC, or prevention of esophagitis during concurrent chemoradiotherapy for non-small cell lung cancer. Palifermin: recommended to decrease severe mucositis in autologous stem cell transplantation (auto-SCT) for hematologic malignancies (HM) with total body irradiation (TBI) conditioning regimens, and consider for patients undergoing myeloablative allogeneic SCT with TBI-based conditioning regimens. Data are insufficient to recommend use in the non-SCT setting.


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