American Society of Clinical Oncology 2008 clinical practice guideline update: use of chemotherapy and radiation therapy protectants.
OBJECTIVE
To update a clinical practice guideline on the use of chemotherapy and radiation therapy protectants for patients with cancer.


METHODS
An update committee reviewed literature published since the last guideline update in 2002.


RESULTS
Thirty-nine reports met the inclusion criteria: palifermin and dexrazoxane, three reports (two studies) each; amifostine, 33 reports (31 studies); and mesna, no published randomized trials identified since 2002.


CONCLUSIONS
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.
Hensley
Martee L
ML
Memorial Sloan-Kettering Cancer Center, New York, NY, USA. guidelines@asco.org
Hagerty
Karen L
KL
Kewalramani
Tarun
T
Green
Daniel M
DM
Meropol
Neal J
NJ
Wasserman
Todd H
TH
Cohen
Gary I
GI
Emami
Bahman
B
Gradishar
William J
WJ
Mitchell
R Brian
RB
Thigpen
J Tate
JT
Trotti
Andy
A
von Hoff
Daniel
D
Schuchter
Lynn M
LM
D004999:Amifostine / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000009:adverse effects*; D051523:Fibroblast Growth Factor 7 / Q000627:therapeutic use*; D006801:Humans; D015080:Mesna / Q000627:therapeutic use*; D009369:Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy*; D017410:Practice Guidelines as Topic; D011837:Radiation-Protective Agents / Q000627:therapeutic use*; D011929:Razoxane / Q000627:therapeutic use*
D000970:Antineoplastic Agents; D011837:Radiation-Protective Agents; D051523:Fibroblast Growth Factor 7; D011929:Razoxane; D004999:Amifostine; D015080:Mesna