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.

ASCO’s practice guidelines and technology assessments reflect expert consensus based on
clinical evidence and literature available at the time they are written, and are intended to assist physicians in clinical decision-making and identify questions and settings for further research.  Due to the rapid flow of scientific information in oncology, new evidence may have emerged since the time a guideline or assessment was submitted for publication.  Guidelines and assessments are not continually updated and may not reflect the most recent evidence.  Guidelines and assessments cannot account for individual variation among patients, and cannot be considered inclusive of all proper methods of care or exclusive of other treatments.  It is the responsibility of the treating physician or other health care provider, relying on independent experience and knowledge of the patient, to determine the best course of treatment for the patient.  Accordingly, adherence to any guideline or assessment is voluntary, with the ultimate determination regarding its application to be made by the physician in light of each patient's individual circumstances.  ASCO guidelines and assessments describe the use of procedures and therapies in clinical practice and cannot be assumed to apply to the use of these interventions in the context of clinical trials.  ASCO assumes no responsibility for any injury or damage to persons or property arising out of or related to any use of ASCO’s guidelines or assessments, or to any errors or omissions.