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

TLDR

The guideline updates recommendations for chemotherapy and radiation therapy protectants based on literature published since 2002. The guideline advises against routine dexrazoxane use in breast cancer but suggests it for metastatic cases after >300 mg/m² doxorubicin, and recommends ongoing cardiac monitoring during doxorubicin therapy. Amifostine is recommended for cisplatin nephrotoxicity, neutropenia, and xerostomia prevention but not for thrombocytopenia, neurotoxicity, mucositis, or esophagitis; palifermin is recommended to reduce severe mucositis in autologous stem‑cell transplantation with total‑body irradiation and considered for myeloablative allogeneic SCT with TBI, while evidence is insufficient for non‑SCT settings.

Abstract

To update a clinical practice guideline on the use of chemotherapy and radiation therapy protectants for patients with cancer.An update committee reviewed literature published since the last guideline update in 2002.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.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.