ZUHL, GermanyAmifostine (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.
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(Drug information on carboplatin) (Paraplatin) 70 mg/m² as a radiosensitizer weeks 1 and 5. Another 14 patients received the same regimen plus amifostine(Drug information on 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."
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.