Originally published as JCO Early Release 10.1200/JCO.2008.17.2627 on November 17 2008

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

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

From the Memorial Sloan-Kettering Cancer Center, New York, NY; American Society of Clinical Oncology, Alexandria; Virginia Cancer Institute, Richmond, VA; St Jude Children's Research Hospital, Memphis, TN; Washington University in St Louis School of Medicine, St Louis, MO; The Cancer Center at Greater Baltimore Medical Center, Baltimore, MD; Loyola University Medical Center; Northwestern University, Chicago, IL; University of Mississippi, Jackson, MS; H. Lee Moffitt Cancer Center, Tampa, FL; Translational Genomics Research Institute, Phoenix, AZ; Lahey Clinic, Burlington, MA; and the University of Pennsylvania, Philadelphia, PA

Corresponding author: American Society of Clinical Oncology, 2318 Mill Rd, Suite 800, Alexandria, VA 22314; e-mail: guidelines{at}asco.org

Purpose 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.

Recommendations 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/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 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.

published online ahead of print at www.jco.org on November 17, 2008

Board Approved: July 21, 2008.

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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