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Titolo:
American Society of Clinical Oncology clinical practice guidelines for theuse of chemotherapy and radiotherapy protectants
Autore:
Hensley, ML; Schuchter, LM; Lindley, C; Meropol, NJ; Cohen, GI; Broder, G; Gradishar, WJ; Green, DM; Langdon, RJ; Mitchell, B; Negrin, R; Szatrowski, TP; Thigpen, JT; Von Hoff, D; Wasserman, TH; Winer, EP; Pfister, DG;
Indirizzi:
Amer Soc Clin Oncol, Hlth Serv Res Dept, Alexandria, VA 22314 USA Amer SocClin Oncol Alexandria VA USA 22314 ept, Alexandria, VA 22314 USA
Titolo Testata:
JOURNAL OF CLINICAL ONCOLOGY
fascicolo: 10, volume: 17, anno: 1999,
pagine: 3333 - 3355
SICI:
0732-183X(199910)17:10<3333:ASOCOC>2.0.ZU;2-#
Fonte:
ISI
Lingua:
ENG
Soggetto:
ADVANCED BREAST-CANCER; HIGH-DOSE IFOSFAMIDE; PHASE-II TRIAL; 2-MERCAPTOETHANE SULFONATE MESNA; DOXORUBICIN-CONTAINING THERAPY; INDUCED HEMORRHAGIC CYSTITIS; ACUTE LYMPHOBLASTIC-LEUKEMIA; BONE-MARROW TRANSPLANTATION; CONGESTIVE HEART-FAILURE; SOFT-TISSUE SARCOMAS;
Tipo documento:
Review
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
113
Recensione:
Indirizzi per estratti:
Indirizzo: Hensley, ML Amer Soc Clin Oncol, Hlth Serv Res Dept, 225 Reinekers Lane,Suite 650, Alexandria, VA 22314 USA Amer Soc Clin Oncol 225 Reinekers Lane,Suite 650 Alexandria VA USA 22314
Citazione:
M.L. Hensley et al., "American Society of Clinical Oncology clinical practice guidelines for theuse of chemotherapy and radiotherapy protectants", J CL ONCOL, 17(10), 1999, pp. 3333-3355

Abstract

Purpose: Because toxicities associated with chemotherapy and radiotherapy can adversely affect short- and long-term patient quality of life, can limit the dose and duration of treatment, and may be life-threatening, specificagents designed to ameliorate or eliminate certain chemotherapy and radiotherapy toxicities have been developed. Variability in interpretation of theavailable data pertaining to the efficacy of the three United States Food and Drug administration-approved agents that have potential chemotherapy- and radiotherapy-protectant activity-dexrazoxane, mesna, and amifostine-and questions about the role of these protectant agents in cancer care led to concern about the appropriate use of these agents. The American Society of Clinical Oncology sought to establish evidence based, clinical practice guidelines for the use of dexrazoxane, mesna, and amifostine in patients who are not enrolled on clinical treatment trials. Methods: A multidisciplinary Expert Panel reviewed the clinical data regarding the activity of dexrazoxane, mesna, and amifostine. A computerized literature search was performed using MEDLINE. In addition to reports collected by individual Panel members, all articles published in the English-speaking literature ham June 1997 through December 1998 were collected for reviewby the Panel chairpersons, and appropriate articles were distributed ta the entire Panel for review. Guidelines for use, revels of evidence, and grades of recommendation were reviewed and approved by the Panel. Outcomes considered in evaluating the benefit of a chemotherapy- or radiotherapy-protectant agent included amelioration of short and long-term chemotherapy- or radiotherapy-related toxicities, risk of tumor protection by the agent, toxicity of the protectant agent itself, quality of rife, and economic impact. Tothe extent that these data were available, the Panel placed the greatest value on lesser toxicity that did not carry a concomitant risk of tumor protection. Results and Conclusion: Mesna: (1) Mesna, dosed as detailed in these guidelines, is recommended to decrease the incidence of standard-dose ifosfamide-associated urothelial toxicity. (2) There is insufficient evidence on which to base a guideline for the use of mesna to prevent urothelial toxicity with ifosfamide doses that exceed 2.5 g/m(2)/d. (3) Either mesna or forced saline diuresis is recommended to decrease the incidence of urothelial toxicity associated with high dose cyclophosphamide use in the stem-cell transplantation setting. Dexrazoxane: (1) The use of dexrazoxane is not routinely recommended for patients with metastatic breast cancer who receive initial doxorubicin-based chemotherapy. (2) The use of dexrazoxane may be considered for patients with metastatic breast cancer who have received a cumulativedosage of 300 mg/m(2) or greater of doxorubicin in the metastatic setting and who may benefit from continued doxorubicin-containing therapy. (3) The use of dexrazoxane in the adjuvant setting is not recommended outside of a clinical trial. (4) The use of dexrazoxane can be considered in adult patients who have received more than 300 mg/m(2) of doxorubicin-based therapy for tumors of her than breast cancer, although caution should be used in settings in which doxorubicin-based therapy has been shown to improve survival because of concerns of tumor protection by dexrazoxane. (5) There is insufficient evidence to make a guideline for the use of dexrazoxane in the treatment of pediatric malignancies, with epirubicin-based regimens, or with high-dose anthracycline-containing regimens. Similarly there is insufficient evidence on which to base a guideline for the use of dexrazoxane in patientswith cardiac risk factors or underlying cardiac disease. (6) Patients receiving dexrazoxane should continue to be monitored for cardiac toxicity. Amifostine: (1) Amifostine may be considered for the reduction of nephrotoxicity in patients receiving cisplatin-based chemotherapy. (2) Although amifostine may be considered for the reduction of neutropenia in patients receiving alkylating agents, chemotherapy dose reduction or growth factor use should be considered err an alternative to the use of amifostine. (3) Present data are insufficient to recommend the use of amifostine for protection against thrombocytopenia or the routine use of amifostine to prevent cisplatin-associated neurotoxicity or ototoxicity. Similarly, present data are insufficient to support the use of amifostine for the prevention of paclitaxel-associated neurotoxicity. (4) Use of amifostine may be considered to decrease the incidence of acute and late xerostomia in certain patients undergoing fractionated radiation therapy in the head and neck region, although presentdata ore insufficient to recommend the use of amifostine to prevent radiation therapy-associated mucositis, Details regarding dose and management of amifostine side effects, including hypotension, are included in the guidelines. Further research is warranted to further define the Kits of these chemotherapy- and radiotherapy-protectant agents in the care of cancer patients. (C) 1999 by American Society of Clinical Oncology.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 03/04/20 alle ore 03:47:55