• 5/2/2007
  • web-based article
  • staff
  • CancerConsultants.com

Researchers from the MD Anderson Cancer Center have reported that response rates for locally advanced non-small-cell lung cancer (NSCLC) to chemotherapy are not affected by Ethyol® (amifostine) cytoprotection. The details of this study appeared in an early on-line publication in the International Journal of RadiationOncology* Biology* Physics on February 6, 2007.

Ethyol® is a radiation protector and the only drug that has been approved by the FDA for this use in patients receiving radiation therapy for cancers of the head and neck. Clinical trials have demonstrated that Ethyol can reduce both acute and late radiation-induced side effects. In the pivotal trial involving patients with head and neck cancer, Ethyol reduced the incidence of xerostomia but had no effect on the incidence or severity of oral mucositis. Ethyol has also been shown to reduce the incidence of grade 2-3 bladder and GI toxicities in patients receiving pelvic radiation therapy. However, the results with Ethyol are conflicting in patients with NSCLC who are receiving radiochemotherapy. A previous study from the MD Anderson Cancer Center reported that Ethyol reduces the severity and incidence of acute esophageal, pulmonary, and hematologic toxicity resulting from concurrent cisplatin-based chemotherapy and radiation therapy in patients with NSCLC.

The authors of this study performed a meta-analysis of 7 randomized trials involving Ethyol in patients with NSCLC treated with radiotherapy with or without chemotherapy. There were 601 patients in these studies and data on response were available on 552 patients. They reported that there were no significant differences in complete or partial response rates in patients receiving or not receiving Ethyol. They concluded that Ethyol had no effect on tumor response in patients with locally advanced NSCLC.

Comments:
A reluctance to use Ethyol routinely stems from the added expense, the necessity to monitor infusions, and the lack of long-term data showing that disease control is not compromised. However, there is mounting evidence that the effects of Ethyol in decreasing toxicities are real and should be considered in patients receiving chemotherapy and radiation for a variety of cancers. The recent documentation that subcutaneous Ethyol was effective should make this a more acceptable drug. The current data on response rates is encouraging but long-term data on recurrences needs to be documented.

Refernce:
Mell LK, Malik R, Komaki R, et al. Effect of amifostine on response rates in locally advanced non-small-cell lung cancer patients treated on randomized controlled trials: A meta-analysis. International Journal of Radiation Oncology* Biology* Physics. 2007;e-pub on February 6, 2007.