ASCO Clinical Practice Guideline Update: Use of Chemotherapy and Radiation Therapy Protectants

Published in Journal of Clinical Oncology, Vol 27, Issue 1 (January), 2009: 127-145
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


To update a clinical practice guideline for chemoprotectant/radioprotectant use in cancer patients.


An Update Committee reviewed an updated systematic review of the literature since 2002.
Results: Thirty-nine reports met the inclusion criteria: palifermin and dexrazoxane, 3 reports (2 studies) each; amifostine, 33 reports (31 studies); mesna, no published randomized trials identified since 2002.


Dexrazoxane: 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 >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 cisplastin-associated nephrotoxicity, reduction of grade 3-4 neutropenia (alternative strategies are reasonable), and to decrease acute and late xerostomia with fractionated radiotherapy alone for head and neck cancer (HNC). Not recommended for protection against thrombocytopenia, prevention of platinum-associated neurotoxicity or ototoxicity or paclitaxel-associated neuropathy, prevention of radiotherapy-associated mucositis in HNC, or prevention of esophagitis during concurrent chemoradiotherapy for non-small cell lung cancer. Palifermin: recommended to decrease severe mucositis in autologous stem cell transplantation (auto-SCT) for hematologic malignancies (HM) with total body irradiation (TBI) conditioning regimens, and consider for patients undergoing myeloablative allogeneic SCT with TBI-based conditioning regimens. Data are insufficient to recommend use in the non-SCT setting.

Guideline Disclaimer

The clinical practice guidelines and other guidance published herein are provided by the American Society of Clinical Oncology, Inc. ("ASCO") to assist practitioners in clinical decision making. The information therein should not be relied upon as being complete or accurate, nor should it be considered as inclusive of all proper treatments or methods of care or as a statement of the standard of care. With the rapid development of scientific knowledge, new evidence may emerge between the time information is developed and when it is published or read. The information is not continually updated and may not reflect the most recent evidence. The information addresses only the topics specifically identified therein and is not applicable to other interventions, diseases, or stages of diseases. This information does not mandate any particular course of medical care. Further, the information is not intended to substitute for the independent professional judgment of the treating physician, as the information does not account for individual variation among patients. Recommendations reflect high, moderate or low confidence that the recommendation reflects the net effect of a given course of action. The use of words like "must," "must not," "should," and "should not" indicate that a course of action is recommended or not recommended for either most or many patients, but there is latitude for the treating physician to select other courses of action in individual cases. In all cases, the selected course of action should be considered by the treating physician in the context of treating the individual patient. Use of the information is voluntary. ASCO provides this information on an "as is" basis, and makes no warranty, express or implied, regarding the information. ASCO specifically disclaims any warranties of merchantability or fitness for a particular use or purpose. ASCO assumes no responsibility for any injury or damage to persons or property arising out of or related to any use of this information or for any errors or omissions.