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Amifostine Can Reduce Xerostomia, Loss of Taste, Fibrosis, and Pain

Amifostine Can Reduce Xerostomia, Loss of Taste, Fibrosis, and Pain

ZUHL, Germany—Amifostine (Ethyol) used as cytoprotective therapy can
reduce the occurrence of xero-stomia, loss of taste, and fibrosis associated
with radiochemotherapy for head and neck cancer. Results of three studies
were reported by Jens Buentzel, MD, PhD, vice chairman of the Department of
Otolaryngology, Head and Neck Oncology, Zentralklinikum Zuhl, Germany.

Pilot Study

The pilot trial was a controlled phase II study involving 14 patients
randomized to receive standard radiochemotherapy, with radiation
administered in 2-Gy fractions to a total dose of 60 Gy plus carboplatin (Paraplatin) 70
mg/m² as a radiosensitizer weeks 1 and 5. Another 14 patients received the
same regimen plus amifostine 500 mg given prior to carboplatin as a short
infusion over approximately 10 minutes. The time interval between amifostine
administration and the end of daily irradiation was less than 60 minutes,
and no cytoprotectant was given on days of radiotherapy alone.

Amifostine significantly reduced mucositis, xerostomia, dysphagia,
ageusia, and dermatitis rates, as well as anemia, leukocytopenia, and
thrombocytopenia. Dr. Buentzel concluded that amifostine could reduce the
typical acute chemotherapy-related toxicities and should be able to reduce
radiation-induced acute toxicities but must be administered within an
interval of no more than 60 minutes following the end of radiotherapy.

"At 5 years after treatment, the survival rate in the amifostine
group is a little bit better than in the control group, and we have no sign
of tumor protection. There was a surprising decrease in nonhematologic
toxicities. These were the first data to show a reduction of mucositis from
amifostine given prior to chemotherapy. We see similar results in clinical
practice. I would like to focus attention on the reduction of severity of
mucositis, dysphagia, and loss of taste. These effects should be examined in
larger studies."

Dose-Intensification Study

This study was followed by a controlled, phase II dose-intensification
study to evaluate the role of intensified carboplatin dosage with amifostine
protection and concomitant radiochemotherapy in locally advanced pharyngeal
cancer.

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