BEP = beomycin/etoposide/cisplatin; NR = not reported; PE = cisplatin/etoposide; PEB = cisplatin/etoposide/bleomycin; PVB = cisplatin/vinblastine/bleomycin;

TIP = paclitaxel/ifosfamide/cisplatin; VIP = vinblastine/ifosfamide/cisplatin.

*World Health Organization grades 2 to 4.

tSee references 13 and 17.

♦See references 14 and 56.

"See references 18 and 56.

'See references 50, 52, and 88.

**See references 38 and 39.

specifically to protect normal tissues from the toxic effects of chemotherapy. The use of G-CSF, mesna, and recombinant EPO was discussed earlier in this chapter. Amifostine, a thiol, is thought to protect cells from damage by scavenging oxygen-derived free radicals and by donating hydrogen to repair damaged target molecules.9 A large randomized trial demonstrated that amifostine could selectively protect against cumulative nephrotoxicity associated with cisplatin-based combination chemotherapy for ovarian cancer.8 In addition, there was a trend toward a decrease in peripheral neuropathy in the group treated with amifostine and, to a lesser extent, a decrease in ototoxicity. While there is evidence from phase I and II trials that supports the finding of protection against nephrotoxicity,86 87 additional data on benefit with regard to neurotoxicity are inconclu-sive.9 Only one small randomized trial has been undertaken to assess the effect of amifostine in patients undergoing chemotherapy for germ cell tumors.39 In that trial, 40 patients who were receiving paclitaxel/ifosfamide/cisplatin followed by peripheral stem cell transplantation with carboplatin and etoposide were randomized to receiving amifos-tine or no treatment. No differences in toxicity were detected between the two groups. However, given the small benefit demonstrated in the other trials described, this study may have been underpowered to detect a difference.39 Although there is no specific evidence of an effect of amifostine in the treatment of germ cell tumors, the current recommendation from the American Society of Clinical Oncology is that amifostine may be considered for the prevention of nephrotoxicity in any patient who receives cis-platin-based chemotherapy.9

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